ITY OF

ERS
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PJPT

UN

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U PT
ISSN NO: (PRINT)
ISSN NO: (ONLINE)
UNIVERSITY INSTITUTE OF
PHYSICAL THERAPY

Inaugural Issue
PAKISTAN JOURNAL OF

RSITY OF
PHYSICAL THERAPY
VOL. 01 ISSUE 01
E Jan-Mar 2018
IV L
UN

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U PT
UNIVERSITY INSTITUTE OF
PHYSICAL THERAPY

PUBLICATION SECRETARIAT
University Institute of Physical Therapy
Main Campus
FACULTY OF
1-Km Defence Road, Near Buptian Chowk,
Off Rawind Road, Lahore. ALLIED HEALTH
Tel: (042) 111-865-865 | Email: pjpt@uipt.uol.edu.pk SCIENCES
 About the Journal

The advancement in technology has been fast during the past two decades. Although it has
rendered many positive impacts and made life extremely fast, just one click away; on the other hand, it
has converted life into sedentary mode. Hence, comes the need and utility of physical therapy. It is one
of the allied health professions that uses biomechanics or kinesiology, manual therapy, exercise
therapy and electrotherapy. It helps to rehabilitate and improves mobility and function.

Here, we are introducing the “Pakistan Journal of Physical Therapy” (PJPT), a pioneer,
international, peer reviewed, open access and quarterly journal. Scope of the journal includes
manuscripts mainly from physical therapy profession and research. It will cover aspects on:

Physical therapy in lifestyle-related health problems

Functioning, activity and participation
Behavioural medicine in physical therapy
Disability and health in areas of pain
Physical activity in health promotion and rehabilitation

The journal prioritizes original studies, systematic reviews, reports of clinical trials, economic
analysis, experimental studies, qualitative analysis, epidemiological studies and observational
studies. Scientic contributions will be accepted in the form of

Case Study
Guest Editorials
Meta-Analysis
Original Research Article
Short communications
Systematic Review

The aim is to improve implementation of research ndings into clinical physical therapy and practice.
There is no author fees for publication

Research scripts can be sent at the following address for review and publications.

Dr. Syed Amir Gilani (Editor in Chief)

Dr. Ashfaq Ahmed (Editor)
Dr. Riffat Mehboob (Editor)
pjpt@uipt.uol.edu.pk

PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018


Instruction to the Authors and Reviewers of the Manuscripts
Pakistan Journal of Physical Therapy (PJPT)
Pakistan Journal of Physical Therapy (PJPT) welcomes contributions that are relevant to the
science or practice of physiotherapy and other allied health sciences.
Human and animal rights
If the work involves the use of human subjects, the author should ensure that the work described
has been carried out in accordance with ‘The Code of Ethics of the World Medical Association’
(Declaration of Helsinki) for experiments involving humans; Uniform Requirements for
manuscripts submitted to Biomedical journals. Authors should include a statement in the
manuscript that informed consent was obtained for experimentation with human subjects. The
privacy rights of human subjects must always be observed.
All animal experiments should comply with the ARRIVE guidelines and should be carried out in
accordance with the U.K. Animals (Scientic Procedures) Act, 1986 and associated guidelines,
EU Directive 2010/63/EU for animal experiments, or the National Institutes of Health guide for
the care and use of Laboratory animals (NIH Publications No. 8023, revised 1978) and the
authors should clearly indicate in the manuscript that such guidelines have been followed.
Conict of interest
To prevent the information on potential conict of interest for authors from being overlooked or
misplaced, it is necessary for that information to be part of the manuscript. It should therefore
also be included as a single line on title page.
Submission declaration and verication
Submission of an article implies that the work described has not been published previously
(except in the form of an abstract, a published lecture or academic thesis, that it is not under
consideration for publication elsewhere, that its publication is approved by all authors and
tacitly or explicitly by the responsible authorities where the work was carried out, and that, if
accepted, it will not be published elsewhere in the same form, in English or in any other
language, including electronically without the written consent of the copyright-holder.
If additional papers have or will be published with any overlap of the current dataset, it is the
authors' responsibility to notify the editor at the time of submission.
Changes to authorship
Authors are expected to consider carefully the list and order of authors before submitting their
manuscript and provide the denitive list of authors at the time of the original submission. Any
addition, deletion or rearrangement of author names in the authorship list should be made only
before the manuscript has been accepted and only if approved by the journal Editor. To request
such a change, the Editor must receive the following from the corresponding author: (a) the
reason for the change in author list and (b) written conrmation (e-mail, letter) from all authors
that they agree with the addition, removal or rearrangement. In the case of addition or removal
of authors, this includes conrmation from the author being added or removed.
Only in exceptional circumstances will the Editor consider the addition, deletion or
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Instructions to the Authors
rearrangement of authors after the manuscript has been accepted. While the Editor considers
the request, publication of the manuscript will be suspended. If the manuscript has already been
published in an online issue, any requests approved by the Editor will result in a corrigendum
Clinical trial results
The policy of PJPT regarding clinical trial registration is consistent with the position of the International
Committee of Medical Journal Editors(ICMJE). Results may be posted in the same clinical trials registry
in which primary registration resides. This will not be considered to be prior publication if the results are
posted in the form of a brief structured (less than 500 words) abstract or table. However, divulging
results in other circumstances (e.g., investors' meetings) is discouraged and may jeopardise
consideration of the manuscript. Authors should fully disclose all posting in registries of results of the
same or closely related work.
Reporting clinical trials
Randomized controlled trials should be presented according to the CONSORT guidelines. At
manuscript submission, authors must provide the CONSORT checklist accompanied by a ow diagram
that illustrates the progress of patients through the trial, including recruitment, enrollment,
randomization, withdrawal and completion, and a detailed description of the randomization procedure.
Registration of clinical trials
Registration in a public trials registry is a condition for publication of clinical trials in this journal in
accordance with ICJME recommendations. Trials must register at or before the onset of patient
enrolment. The clinical trial registration number should be included at the end of the abstract of the
article. A clinical trial is dened as any research study that prospectively assigns human participants or
groups of humans to one or more health-related interventions to evaluate the effects of health outcomes.
Health-related interventions include any intervention used to modify a biomedical or health-related
outcome (for example drugs, surgical procedures, devices, behavioural treatments, dietary
interventions, and process-of-care changes). Health outcomes include any biomedical or health-related
measures obtained in patients or participants, including pharmacokinetic measures and adverse events.
Purely observational studies (those in which the assignment of the medical intervention is not at the
discretion of the investigator) will not require registration.
Authorship Letter:
The corresponding author has to submit an authorship letter at the time of submission of manuscript,
duly signed by all co-authors along with description of their contributions, afliations and email
addresses. Declaration of any potential conict of interest, transfer of copyrights and funding will also
be mentioned in it.
Open access
This is an open access journal: all articles will be free for everyone to read and download.
Informed consent and patient details
Studies on patients or volunteers require ethics committee approval and informed consent, which
should be documented in the paper. Appropriate consents, permissions and releases must be obtained
where an author wishes to include case details or other personal information or images of patients and
any other individuals in PJPT publication. Written consents must be retained by the author but copies
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
 Instructions to the Authors
should not be provided to the journal. Only if specically requested by the journal in exceptional
circumstances the author must provide copies of the consents or evidence that such consents have been
obtained.
Submission
Manuscripts may be submitted to the following email address:
pjpt@uol.edu.pk
All correspondence, including notication of the Editor's decision and requests for revision, is sent by
e-mail.
Article length
Manuscript length (not including title page, abstract, references, tables or gure legends) depends on
the type of study:
Systematic reviews: up to 5000 words
Clinical trials, experimental and qualitative studies: up to 3500 words
Observational studies: up to 2500 words
Peer review
This journal operates a double blind review process. All contributions will be initially assessed by the
editor for suitability for the journal. Papers deemed suitable are then typically sent to a minimum of two
independent expert reviewers to assess the scientic quality of the paper. The Editor is responsible for
the nal decision regarding acceptance or rejection of articles. The Editor's decision is nal.
Editorials
Pakistan Journal of Physiotherapy (PJPT) publishes two editorials on scientic or professional issues of
physiotherapy practice and other health related matters and innovations in each issue. Editorials are
usually commissioned; however, anyone wishing to write an editorial should contact the Journal Editor
for discussion about the topic. Editorials should be no more than 2000 words with a maximum of three
authors and 20 references. Commissioned editorials are not formally peer reviewed, but may be subject
to informal review. Non-commissioned editorials will be formally peer reviewed.
Manuscript preparation
Essential title page information
Title. Concise and informative. Titles are often used in information-retrieval systems. Avoid
abbreviations and formulae where possible.
Running title: Write a short running title on title page
Author names and afliations. Please clearly indicate the given name(s) and family name(s) of each
author and check that all names are accurately spelled. Present the authors' afliation addresses (where the
actual work was done) below the names. Indicate all afliations with a lower-case superscript letter
immediately after the author's name and in front of the appropriate address. Provide the full postal address
of each afliation, including the country name and, if available, the e-mail address of each author.
Corresponding author. Clearly indicate who will handle correspondence at all stages of refereeing and
publication, also post-publication. This responsibility includes answering any future queries about
Methodology. Ensure that the e-mail address and contact number is given and that contact details are kept
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Instructions to the Authors
up to date by the corresponding author.The corresponding author details should be included on title
page. Email address should be institutional and including the name of corresponding author.
Present/permanent address. If an author has moved since the work described in the article was done,
or was visiting at the time, a 'Present address' may be indicated as a footnote to that author's name. The
address at which the author actually did the work must be retained as the main, afliation address.
Superscript Arabic numerals are used for such footnotes
Word count
Mention the word count of the manuscript (without references) on the title page.
Highlights
Highlights consist of a short collection of bullet points that convey the core ndings of the article.
Please include 3 to 5 bullet points to explain the key ndings.
Abstract
Abstract should comprise of the following: Background,Objective , Design, Methodology, Results,
Conclusion, Recommendations. A concise and factual abstract is required. The abstract should state briey
the purpose of the research, the principal results and major conclusions. An abstract is often presented
separately from the article, so it must be able to stand alone. For this reason, References should be avoided,
but if essential, then cite the author(s) and year(s). Also, non-standard or uncommon abbreviations should
be avoided, but if essential they must be dened at their rst mention in the abstract itself.
Keywords
Immediately after the abstract, provide a maximum of 6 keywords, using Australian / British spelling
and avoiding general and plural terms and multiple concepts (avoid, for example, 'and', 'of'). Be sparing
with abbreviations: only abbreviations rmly established in the eld may be eligible. These keywords
will be used for indexing purposes.
Units and Abbreviations
This journal does not favour abbreviations in the text. However, 95% CI, SD, OR, RR, MD and such
commonly used terms do not require spelling out in full at rst mention (they would usually appear
within parentheses), but even when presented outside of parentheses these do not require dening. The
journal uses an approved list of units and abbreviations.
Introduction
State the objectives of the work and provide an adequate background, avoiding a detailed literature
survey or a summary of the results
Methodology
Provide sufcient details to allow the work to be reproduced by an independent researcher. Methods
that are already published should be summarized, and indicated by a reference. If quoting directly from
a previously published method, use quotation marks and also cite the source. Any modications to
existing methods should also be described.
Results
Results should be clear and concise.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
 Instructions to the Authors Instructions to the Authors

Discussion E-mail address

This should explore the signicance of the results of the work, not repeat them. Avoid extensive citations Full postal address
and discussion of published literature. All necessary les have been uploaded, and contain:
Keywords
Conclusions All gure captions
The main conclusions of the study should be presented in a short concluding paragraph at the end of the All tables (including title, description, footnotes)
Discussion section. Further considerations
Figures Manuscript has been 'spell-checked' and 'grammar-checked'
Ensure that each illustration has a caption. Supply captions below the gure. A caption should comprise References are in the correct format for this journal
a brief title and a description of the illustration. Keep text in the illustrations themselves to a minimum All references mentioned in the Reference list are cited in the text, and vice versa
but explain all symbols and abbreviations used. Include the number of gures on title page. Maximum Permission has been obtained for use of copyrighted material from other sources (including the
number of gures or images is 4. Internet)

Tables
Please submit tables as editable text and not as images. Tables can be placed either next to the relevant
text in the article, or on separate page(s) at the end. Number tables consecutively in accordance with their
appearance in the text and place any table notes below the table body. Be sparing in the use of tables and
ensure that the data presented in them do not duplicate results described elsewhere in the article. Please
avoid using vertical rules and shading in table cells.Write captions below the table. Include the number
of tables on title page. Maximum number of tables to be included is 4.

References
Citation in text
Please ensure that every reference in the text should be mentioned as arabic numerals in
superscript.Reference cited in the text is also present in the reference list (and vice versa). Any references
cited in the abstract must be given in full. Unpublished results and personal communications are not
recommended in the reference list, but may be mentioned in the text. If these references are included in
the reference list they should follow the standard reference style of the journal and should include a
substitution of the publication date with either 'Unpublished results' or 'Personal communication'.
Citation of a reference as 'in press' implies that the item has been accepted for publication.

Reference management software

Use the support of Citaion Style Language styles, such as Mendeley and Zotero, as well as EndNote.
Reference style
Text: Indicate references by (consecutive) superscript arabic numerals in the order in which they appear
in the text. The numerals are to be used outside periods and commas, inside colons and semicolons.
The referencing style used by the journal is the Vancouver style, which can be found as a standard
referencing style in EndNote, RefWorks, Mendeley, and Zotero.
Submission checklist
The following list will be useful during the nal checking of an article prior to sending it to the
journal for review. Please consult this Guide for Authors for further details of any item.
Ensure that the following items are present:
One author has been designated as the corresponding author with contact details:

PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
 Pakistan Journal of Physical Therapy
University Institute of Physical Therapy
The University of Lahore
Lahore, Pakistan
ISSN Applied (Online), ISSN Applied (Print) VOL. 01 ISSUE 01 Jan-Mar 2018
Editorial Board & Peer Reviewers
Patron in Chief Members (National)
Mr. M.A. Raoof Amir Qazi, Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Aurangzaib, Professor (Ph.D)
Patron
The University of Lahore, Lahore, Pakistan.
Mujahid Kamran, Professor
(Ph.D) Fridoon J Ahmad, Professor (Ph.D)
King Edward Medical University,
Editor in Chief Lahore, Pakistan.
Syed Amir Gilani, Professor Nasir Raza Zaidi, Professor (MD, Ph.D)
(MBBS, DMRD, MD, MPH, Ph.D) Gujranwala Medical College Gujranwala Pakistan.
Editors Nazar Ullah Raja, Professor (M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Ashfaq Ahmad, Associate Prof.
(M.Phil Ph.D- PT) Saira Afzal, Professor
(MBBS, FCPS, Ph.D, Post Doc)
Riffat Mehboob, Professor King Edward Medical University,
(M.Phil, Ph.D, Post Doc.) Lahore, Pakistan.
Syed Shakeel ur Rehman Professor
Editorial Assistant: (DPT, M.Phil, Ph.D)
Riphah International University,
Sidra Khalid
(M.Phil, Ph.D*)
Islamabad, Pakistan.
Asif Hanif, Associate Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Fareeha Hameed, Associate Professor
(Ph.D, Post Doc)
Forman Christian College , Lahore, Pakistan.
Farhat Bano, Associate Professor
(M.Phil, Ph.D)
University of Health Sciences, Lahore, Pakistan.
Jamshaid Ahmed, Associate Professor
(Ph.D)
The University of Lahore, Lahore, Pakistan.
Muhammad Imran, Associate Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Nadeem Sheikh, Associate Professor
(Ph.D, Post Doc)
The University of Punjab, Lahore, Pakistan.
Roquyya Gul, Associate Professor
(M.Phil, Ph.D, Post Doc)
The University of Lahore, Lahore, Pakistan.
Shahid Bashir, Associate Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Shahida Parveen, Associate Professor
(MBBS, M.Phil)
Services Hospital, Lahore, Pakistan.
Ammar Ahmed Khan,
Assistant Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Arif Ali Rana, Assistant Professor
(DPT, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Arooj Fatima, Assistant Professor
(DPT, M.Phil, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Arooj Munawar, Assistant Professor
(BSPT, PP-DPT)
The University of Lahore, Lahore, Pakistan.
Asif Naveed, Assistant Professor
(MBBS, FCPS)
King Edward Medical University,
Lahore, Pakistan.
Attia Masood Ahmed Ch,
Assistant Professor (Ph.D)
The University of Lahore, Lahore, Pakistan.
Ayesha Riaz, Assistant Professor
(M.Phil, Ph.D)
Govt. College Women University, Faisalabad, Pakistan.
Danish Ali Khan, Assistant Professor
(MS, Ph.D*)
Khyber Medical College, KPK, Pakistan
Ehsan Javed, Assistant Professor
(T-DPT, Ph.D*)
University of South Asia, Lahore, Pakistan.
Fahad Tanveer, Assistant Professor
(MSOMPT, DPT, MHA, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Faiza Sharif, Assistant Professor
(MS, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Fareeha Amjad, Assistant Professor
(MSPT, Ph.D*)
The University of Lahore, Lahore, Pakistan
Filza Shoukat, Assistant Professor
(DPT, MSOMPT,)
The University of Lahore, Lahore, Pakistan.
Huma Ikram, Assistant Professor
(M.Phil, Ph.D)
University of Karachi, Karachi, Pakistan.
Ishaq Ahmed, Assistant Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Kashifa Ehsan, Assistant Professor
(MBBS, M.Phil)
Shaukat Khanum Memorial Cancer Hospital,
Lahore, Pakistan.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
ISSN Applied (Online), ISSN Applied (Print) VOL. 01 ISSUE 01 Jan-Mar 2018
Editorial Board & Peer Reviewers
Kashaf Junaid, Assistant Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Maria Fareed Siddiqi, Assistant Professor
(D-Pharm, Ph.D)
The University of Lahore, Lahore, Pakistan.
Muhammad Kashif, Assistant Professor
(DPT, MSOMPT, Ph.D*)
Riphah International University, Faisalabad
Munir Bhinder, Assistant Professor
(M.Phil, Ph.D)
University of Health Sciences, Lahore, Pakistan.
Muhammad Nazim Farooq,
Assistant Professor (DPT, Ph.D)
Margalla Institute of Health Sciences,
Rawalpindi, Pakistan.
Muhammad Waseem Akhtar,
Assistant Professor (DPT, Ph.D)
Doctors Hospital & Medical Center,
Lahore, Pakistan.
Nighat Yasmin, Assistant Professor
(Ph.D, Post Doc)
King Edward Medical University,
Lahore, Pakistan.
Rabail Rani Soomro, Assistant Professor
(MS, Ph.D*)
DOW University, Karachi, Pakistan
Raham Bacha, Assistant Professor
(M.Phil, Ph.D*)
The University of Lahore, Lahore, Pakistan.
Rizwan Ullah Khan, Assistant Professor
(MBBS, FCPS)
Fatima Memorial Hospital, Lahore, Pakistan.
Saeed Akhtar, Assistant Professor
(MS, Ph.D*)
DOW University, Karachi, Pakistan
Sajid Shaheen Malik, Assistant Professor
(MBBS, DMRD)
The University of Lahore, Lahore, Pakistan.
Sahreen Anwar, Assistant Professor
(MS, Ph.D*)
University of Sargodha, Sargodha, Pakistan.
Sana Batool, Assistant Professor
(MSPT, Ph.D*)
The University of Lahore, Lahore, Pakistan
Shahnai Basharat, Assistant Professor
(M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan.
Pakistan Journal of Physical Therapy
University Institute of Physical Therapy
The University of Lahore
Lahore, Pakistan
Syeda Arooj Fatima, Assistant Professor Members (International)
(M.Phil, Ph.D*) Hossein Karimi, Professor (Ph.D),
The University of Lahore, Lahore, Pakistan. Isfahan University of Medical Sciences, Isfahan, Iran.
Syed Ijaz Ahmad, Assistant Professor Humayoun Zafar Professor (Ph.D)
(M.Phil, Ph.D*)
King Saud University Riyadh, KSA.
Lahore General Hospital, Lahore, Pakistan.
Muhammad Ali Mohseni Bandpei,
Tamseela Mumtaz, Assistant Professor Professor (Ph.D)
(Ph.D) University of Social Welfare & Rehabilitation
Govt. College for Women University, Faisalabad, Pakistan. Sciences, Tehran, Iran.
Umair Ahmed, Assistant Professor Ahmad Azam Malik, Associate Professor
[BSPT, MSPT (Neuro), Ph.D*] (M.Phil, Ph.D)
The University of Lahore, Lahore, Pakistan. King Abdul Aziz University, Jeddah, KSA.
Usma Iftikhar, Assistant Professor Imrana Tanvir, Associate Professor
(MBBS, M.Phil Ph.D*) (MBBS, FCPS)
Mayo Hospital, Lahore, Pakistan. King Abdul Aziz University, Rabigh, KSA.
Waqar Afzal, Assistant Professor Muhammad Akram Tariq,
(DPT, M.Phil, Ph.D*) Associate Professor
The University of Faisalabad, Lahore Campus, (M.Phil, Ph.D, Post Doc)
Qingdao University Medical college, Qingdao, China.
Lahore, Pakistan.
Muhammad Ikram Ullah,
Assistant Professor
(M.Phil, Ph.D, Post Doc)
Al Jouf University, KSA.
Naseer Ahmad, Assistant Professor
(MBBS, Ph.D, Post Doc)
University of Verona Medical School, Verona, Italy.
Agha Khan Medical University, Karachi, Pakistan.
Abida Siddiqa, Research Scientist
(M.Phil, Ph.D, Post Doc)
ICGEB, Trieste, Italy.
Ayisha Shabbir, Research Scientist
(M.Phil, Ph.D, Post Doc)
University College London, London, UK.
Jaspreet Kaur, Research Scientist
(Ph.D, Post Doc)
Aix-Marseille University, Marseille Cedx, France.
Muhammad Sulaiman Yousafzai,
Research Scientist
(Ph.D, Post Doc)
University of Yale, New Haven, CT, USA.
Saima Zafar, Research Scientist
(M.Phil, Ph.D, Post Doc)
Georg-August-University Gottingen,
Gottingen, Germany.
Shakeel Ahmed, Research Scientist
(M.Phil, Ph.D, Post Doc)
Georg-August-University Gottingen, Gottingen,
Germany.
Syed Adnan Shahzad, Research Scientist
(Ph.D, Post Doc)
University of Cologne, Cologne, Germany.

ISSN Applied (Online), ISSN Applied (Print) VOL. 01 ISSUE 01 Jan-Mar 2018
Biostatisticians
Asif Hanif (M.Phil, Ph.D)
Arslan Saleem Chughtai (M.Phil*)
Humera Waseem (MS*)
Maryam Altaf (MS*)
Sadia Khan (M.Phil*)
Mahreen Fatima (M.Phil, Ph.D*)
Coordinators
Amber Hassan (M.Phil, Ph.D*)
Sadia Khan (M.Phil*)
Managerial Assistant
Riffat Rehman (M.Phil*)
Publication Office
Prof. Dr. Riffat Mehboob
Editor
Research Unit,
Faculty of Allied Health Sciences
The University of Lahore,
Defence Road Campus
Lahore, Pakistan
Mailing Address: pjpt@uipt.uol.edu.pk
http://journal.uol.edu.pk/pjpt
Disclaimer:
All articles published represent the view of the authors and do not reect any ofcal policy of the Pakistan
Journal of Physical Therapy. All the copy rights are reserved with PJPT. No part of the journal may be
reproduced by any from or any mean without written permission from the Editor in Chief.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Pakistan Journal of Physical Therapy
University Institute of Physical Therapy
The University of Lahore
Lahore, Pakistan
Physical therapy and primary
health care system
Vaping or Smoking:
What is more dangerous?
Correlation between hand
1- circumference and maximum
grip strength
Prevalence of upper extremity
2- musculoskeletal disorders in
health professionals in Lahore
Correlation between level of
3- depression, sleep disturbance
and suicidal thoughts among
lower limb amputees
The effect of shoulder position
4- on hand grip strength among
university students
Awareness & attitude
5- towards physical activity
among pediatric population
in Pakistan
Facilities available for cerebral
6- palsy children in different
setups of Lahore
LETTER OF AUTHORSHIP
MANUSCRIPT SUBMISSION PATHWAY
Prof. Dr. Syed Amir Gilani
Dr. Nighat Yasmin
Muhammad Noman Tasawer,
Ashfaq Ahmad & Sadia Khan
Wazahat Nasir, Amber Hassan
& Fareeha Amjad
Anna Zaheer, Faiza Sharif, Nida Fatima,
Ayesha Shaque & Zeeshan Khan
Babar Bashir, Arooj Ashfaq &
Maryam Altaf
Muhammad Jawad, Fahad Tanveer,
Wardah Rauf & Haz Zain Pervaiz
Muhammad Faizan Hamid,
Muhammad Waqar Afzal,
Arslan Saleem Chughtai
& Khalil Ahmad
Editorial
Physical Therapy and primary health care system
The University of Lahore, feels pride and privileged to launch 'Pakistan Journal of Physical
Therapy'. It was need of the hour and an under-recognized eld in Pakistan. It will include rigorous
research work with clear implications for the clinical practice of physical therapy. It will disseminate
high quality, original research in physical therapy and facilitate continuing education for physical
therapists and other healthcare professionals. Primary health is a state of complete physical, mental
01 and social well-being which is essential for leading a productive life and is a fundamental right of
every human being.
According to WHO, “Primary healthcare refers to "essential healthcare" that is based on
"scientically sound and socially acceptable methods and technology, which make universal health
care accessible to all individuals and families in a community. It is through their full participation and
02
at a cost that the community and the country can afford to maintain at every stage of their
development in the spirit of self-reliance and self-determination".1
Primary medical care system caters a medically ill person for treatment and cure. Physicians
03 solely treat these patients and only health sector is involved in it. While, primary health care system
deals with prevention, care as well as palliative care leading to cure. It helps in health promotion and
comprehensive care which involve health professional teams, collaborations, community
participation and is joint responsibility of all of them.
10
Pakistan is a developing country, with 60 million people living under poverty line.2 According
to World Bank, approximately 4% of the population in Pakistan falls into poverty due to health shocks
each year. Majority of the people are without primary health care facilities and there is a shortfall of
14 specialists.2 Here comes the role of a physical therapist! It is a health care profession involving the
examination, evaluation, diagnosis of patients and treating them with physical interventions for
healing of imapairments and disabilities. Helps in promoting ambulation, functional abilities and
improvement of quality of life.
19
It is concerned with maximizing the quality of life by increase in movement potential for
promotion, prevention, treatment and ultimately rehabilitation of people. There are no retirement
homes at Government level for the proper care of geriatric population in Pakistan. Proportion of such
24 immobile population need long term and constant care. Our health care systems are not adequality
equipped and planned for them. Physical therapists may provide callipers, supportive devices and
create public awareness on promotional, preventive and rehabilitative measures. They provide
counselling to the family members of patients for home based care. It will help in managing the per
29 capita costs, improve team function, cost effective solution for addressing musculoskeletal conditions.
Reference:
35 1- World Health Organization. Declaration of Alma-Ata. Adopted at the International
Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978
36
2- DAWN: Mubarak Zeb Khan, 2016. www.dawn.com/news/1250694
Editor in Chief
Prof. Dr. Syed Amir Gilani
Faculty of Allied Health Sciences
University of Lahore
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 01
 Correlation between Hand Circumference and Maximum Grip Strength
Guest Editorial
Muhammad Noman Tasawer1*, Ashfaq Ahmad and Sadia Khan1
Vaping or smoking: What is more dangerous? 1
University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
*nomanbhatti784@gmail.com
E-Cigarette (EC) is an electronic device that is used as an alternative to conventional tobacco
cigarettes (TS). It is gaining popularity in the young adults as it is considered safe for health. EC have Highlights:
been promoted as an alternative harmless source to deliver the same effects as TS. The term “vaping”
is commonly used for EC while “smoking” is used for TS. EC can deliver nicotine through a gaseous Maximum Grip-Strength (MGS) is inuenced
state because nicotine is dissolved in relatively harmless organic solvents such as glycerol and by gender, BMI, forearm and hand
propylene glycol that produce aerosols (nicotine stimulants) upon controlled electric heating. Since circumference.
EC does not contain any carcinogen, it is believed that EC smoke have no harmful effects on health. On
Hand circumference is the best predictive of
the other hand, TS contain nicotine and its nitrosamine derivatives alongwith hundreds of byproducts
MGS in males and females for right and left
such as Polycyclic Aromatic Hydrocarbons (PAHs), aromatic amines, aldehydes and benzene that are
hands than forearm circumference and BMI.
mostly reported as human carcinogens. Therefore, TS smoke is not only harmful for the users but also
Males have higher BMI, hand and forearm
for the bystanders.
circumference and grip-strength than females.
EC users often state that it save you from smoking related health risks, yellowing of skin and
Abstract:
teeth, halitosis and deteriorating physical condition because EC do NOT use tobacco. EC companies
claim that it contains only nicotine alongwith FDA approved food grade components. Moreover, Grip Strength (GS) is a reliable parameter that
reveals general hand condition and to determine
nicotine is a stimulant just like caffeine and is also found in trace amounts in vegetables such as
tomatoes, potatoes and even eggplants. Therefore, to eliminate the use of TS via EC will not cause effectiveness of treatment protocol. GS is also
cancer and FDA would not have approved nicotine gums as smoking cessation tools if nicotine really effective for rehabilitation of hand also for
cause cancer. However, these are irresponsible and irrational marketing tacts. ergonomists as a way of optimizing the
requirements of hand tool design.
Studies have shown that EC users are more inclined to become smokers in future. Scientists Objective:
have found that heavy metals like chromium, nickel, tin, silver, cadmium, mercury and aluminum are
To measure the relationship between hand
present in the vapors produced by EC. The existence of various harmful chemicals such as nicotine,
carbonyls, metals, and organic volatile compounds has been proved to be present in EC smoke. A circumference, BMI, forearm circumference and
recent study has shown that EC smoke can damage DNA and reduce the repair capacity of a number of maximum hand grip strength.
organs like lung, heart and bladder cells. Therefore, EC smoke may be equally carcinogenic as TS Methodology:
smoke and EC smokers are also a higher risk of developing lung and bladder cancer and heart Cross-sectional study design was used. After
diseases. No data or study is available from Pakistan regarding EC use and its effects on health. obtaining informed consent form 62 healthy
Therefore, this can be a future perspective of Pakistani scientists to study EC effect on health as more participants, 40 males and 22 females in the age
human studies needed to validate that vaping is equally/more dangerous than smoking. group 19 to 26 years were recruited. Participants
were selected using a non-random convenience
sampling method. GS was measured using
Jamar Plus Digital Dynamometer. Body mass
index, hand and forearm circumference in males
and females were measured. Pearson's
correlation coefcient test was applied to
evaluate the correlation and 5% probability level
was applied to specify the statistical-
Dr Nighat Yasmin signicance.
Assistant Professor Results:
Signicant correlation between body mass
Department of Biomedical Sciences,
Kind Edward Medical University, Lahore. index, hand and forearm circumference with
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 02 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
GS. Hand circumference had the strongest
correlation with MGS for both hands in males
(right r=.771**, left r=.731**) and females (right
r=.768**, left r=.737**) Forearm circumference
had the moderate relationship with MGS for
both hands in males (right r=.631**, left r=.629**)
and in females (right r=.639**, left r=.624**). Body
mass index had the weakest correlation with
MGS in females (right r=.424*, left r=.450*)
whereas, males have moderate relationship
(right r=.528**, left r=.527**). Males have higher
hand grip strength than females for right hand
(102.32±13.55, 48.87±7.99) and left hands
(93.99±13.09, 42.66±8.29) respectively.
Conclusions:
MGS was inuenced by gender, BMI, forearm
and hand circumference. Hand circumference is
the best predictive of MGS in males and females
for right and left hands than forearm
circumference and BMI.
Key Words:
Hand circumference, Forearm circumference,
Maximum grip strength
Introduction:
Health and appropriate strength of
musculoskeletal system is one of the essential
components to perform routine movement.
Along with routine movement hand grip
strength is fundamental to various games and is
considered while an ingredient in enhancing
action and control.1 The human hand is a
complicated architecture and is most responsible
to the purpose of manipulation. It helps in
transfer of sensory information about
temperature, shape and surface of any object to
2
the brain. Measuring GS is easy, but evaluation
of the Hand Grip Strength (HGS) has several
03
 Tasawer MN et al.,
importance that reveal someone's overall health,
3, 4
muscle strength, or even aging. GS is the
power of many muscles in the hand and its
strength is the strong bending of whole nger
joints, with a maximum intentional force. The
strength has usually been measured in kilograms
(kg) and pounds (lbs), some studies have also
used milliliters of mercury (mmHg) and also
newton's. Anakwe et al., has observed that
relation with hand and lower arm circumference
have also been considered to be exceptional sign
5 64.50%, 22 females 35.48%) with mean age
of HGS . Studies have also conrmed that HGS is
changed through position and other
anthropometrical characteristics alike ratio of the
fat your body contain and hand circumference
6
Gender and age are the two main causes
affecting maximum hand grip strength, where
gender accounts for the major percentage of the
general change.7
The anthropometric traits depend on
populations and are changed for many ethnic
populations. Even for a population of the same
ethnic group, some differences in hand
dimensions are noticed. Furthermore, the
association between GS with interrelated
8
variables is different in many studies. GS testing
is used to make decisions for returning those
who suffer from local hand injuries back to work
and to estimate the amount of bone mineral
density.7, 9 GS is of signicance to ergonomists as
a way of enhancing the demands of workplaces
and tools strategy10 Handheld-dynamometers
have been utilized to evaluate muscle power.
The Jamar Hydraulic Hand Dynamometer was
detected to provide the much precise plus
satisfactory measurement of HGS.
11, 12
Ke Li et al., had done a research in 2010 and
concluded that MGS can be forecasted utilizing
13
hand circumference only. Manjunath Hemberal
et al., had done a research in 2014 and concluded
that the hand circumference had the greatest
14
association with MGS in both genders. Kumar et
al., had done a research in 2016 and established
that hand circumference is a worthy forecaster of
15
GS as compared to body mass index. There is no
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Hand Circumference and Maximum Grip Strength Tasawer MN et al. Hand Circumference and Maximum Grip Strength
published data available on present study in examine the variances among genders. Gender Mean± SD p-value
Pakistan. The main purpose of this study is to Moreover, paired-sample t test was Male 5.62±0.3
Height 0.008*
search the correlation between anthropometrical implemented to analyse strength variability Female 5.43±0.18
characteristics like body mass index, hand and among right and left hands. To inspect the Male 69.76±12.19
Weight <0.001*
Female 55.5±8.85
forearm circumference with MHGS in normal relationship between MGS and other Male 23.49±3.71
population. The study will be unique that will try BMI 0.011*
anthropometric factors, Pearson correlation Female 20.96±3.48
to further characterize and describe the test was used. The correlations were Male 21.11±0.91
Right Hand Circumference (cm) <0.001*
statistically signicant anthropometrics characterized according to Hopkins' scale16
Female 18.88±1.01
variables related to HGS. GS is a reliable Male 20.75±0.93
Results: Left Hand Circumference (cm) <0.001*
parameter that reveal general hand condition Female 18.55±0.96
A total 62 healthy participants (40 males
and to determine effectiveness of treatment Male 26.54±1.78
Right Forearm Circumference (cm) <0.001*
protocol. Female 23.98±2.19
Methodology: 21.45±1.73 years, all of the participants were Male 26.02±1.82
recruited from university of Lahore, Lahore. Left Forearm Circumference (cm) <0.001*
Cross-sectional study was done after approval Female 23.5±2.18
from the Ethical Committee. Sixty two healthy Table1 represent the anthropometric Male 102.32±13.55
characteristics and MGS of the participants. Right Hand MGS (lbs) <0.001*
participants including 40 males and 22 females in Female 48.87±7.99
the age class 19-27 were approached and the Mean Height of male and female subjects were Male 93.99±13.09
Left Hand MGS (lbs) <0.001*
subjects signed an informed consent form before 5.62±0.30, 5.43±0.18 respectively and have p- Female 42.66±8.29
contribution. Data was collected through value 0.008 which shows statistically
questionnaire planned for the aim of this study signicant difference between both genders, Table 1: Anthropometric parameters and
which includes socio demographic information males are taller than females. Maximum Grip-strength of the participants
like name, age, gender, hand dominance, BMI was signicantly greater in males than
occupation. Participants with any wrist and females (males 23.49±3.71, females
elbow joint complications, fracture history, 20.96±3.48). Right and left hand circumference Table 2 represents the Pearson's correlation of
upper extremity abnormalities, hand swelling, were signicantly larger in males than females anthropometric parameters with MGS among
any vascular problem, hand edema, any (males 21.11±0.91, females 18.88±1.01), (males males. Hand circumference had the highest
neurological problem. MHGS was counted by correlation with maximum grip-strength for
20.75±0.93, females 18.55±0.96) respectively.
asking the participants seated in chair without an both right and left hands in males (right r =
Right and left FAC were signicantly larger in
arm rest with 90 degrees elbow exed and with .771**, left r = .731**). Forearm circumference
males than females (males 26.54±1.78, females
wrist slight extended and slightly deviation on had the moderate relationship with MGS for
23.98±2.19), (males 26.02±1.82, females
ulnar side. The subjects were asked to grip the both hands in males (right r = .631**, left r =
23.50±2.18) respectively Right hand MGS is
dynamometer with maximum force. Three trials .629**). BMI had the moderate relationship
for both right and left hands with normal period
signicantly larger in males than females
(males102.32±13.55, 48.87±7.99). Left hand with MGS in males (right r = .528**, left r =
of one min rest interval between trials were
MGS is signicantly larger in males than .527**).
accomplished. The maximum force was
sustained for period of two to three seconds and females (males 93.99±13.09, females
best value out of three was recorded and the 42.66±8.29). There were variations in grip-
result was taken in lbs. The BMI was measured strength of both hands in males and females;
utilizing person's weight in kilograms divided right hand was stronger than left.
by height in meters squared (kg)/(m)².The
forearm and hand circumference was Abbreviations SD= Standard Deviation, BMI=
measured using exible measuring tape(cm) body mass index, MGS= maximum grip
and correlated with MGS. The analyses of the strength.
data were accomplished by SPSS version 21. *independent sample t test, p-value signicant
An independent-sample t test was applied to at 0.05
04 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 05
 Tasawer MN et al. Hand Circumference and Maximum Grip Strength Tasawer MN et al. Hand Circumference and Maximum Grip Strength

class 19 to 27 years were gathered and it revealed circumference was found moderate in males and
Right Left HC Right Left FAC Right Hand Left Hand that there is signicant difference in females for right and left hands. Previous study
HC(cm) (cm)
FAC (cm) (cm)
MGS (lbs) MGS (lbs) anthropometrical characteristics of both males results found lower relation between these two
and females, overall, male variables in both genders28 whereas, Nicolay and
BMI 0.576** 0.595** 0.732** 0.734** 0.528** 0.527**
participants(5.62±0.30)are taller than their Walker established a strong association between
Right HC (cm) 0.982** 0.744** 0.742** 0.771** 0.734** these two variables.29
counterparts(5.43±0.18)and their
Left HC(cm) 0.747** 0.754** 0.766** 0.731** anthropometrical characteristics are greater than The present study illustrate that there was
(cm) female participants including BMI, hand positive correlation between anthropometrical
Right FAC 0.992** 0.631** 0.626**
circumference, forearm circumference. This characteristics like BMI, hand circumference and
Left FAC (cm) 0.632** 0.629** shows that height, weight, BMI, hand forearm circumference and maximum grip
Right hand circumference and forearm circumference have strength in both genders while, strongest
0.973**
MGS (lbs) signicantly inuenced by gender. These result correlation was found between maximum grip
Table 2: Pearson's correlation between anthropometric parameters with MGS among males correlates well with the ndings in earlier strength and hand circumference. This
Abbreviations HC=Hand circumference, FAC=Forearm circumference, MGS=Maximum grip studies
20-22
Overall, it can be concluded that conclusion was related to the report from survey
strength, BMI= Body mass index. anthropometrical characteristics like weight, which revealed strong relationship between
13
**. Correlation is signicant at the 0.01 level (2-tailed) height, BMI, hand and forearm circumference MGS and hand-circumference .
were considerably different between both males
Table 3 represents the Pearson's correlation of anthropometric parameters with MGS among females. and females. Conclusions:
Hand circumference had the highest relationship with MGS for both hands in females (right r = .768**, In this study the maximum grip strength of 62 It can be concluded that MGS is inuenced by
left r = .737**) whereas, Forearm circumference had the moderate relationship with maximum grip- participants [22 (64.5%) male and 40 (35.5%) gender, BMI, forearm and hand circumference.
strength in females (right r = .639**, left r = .624**). Body mass index had the weakest correlation with female] of mean age 21.45±1.734 years were Hand circumference is a best predictive of
MGS in females (right r = .424*, left r = .450*). assessed using a Jamar Plus Digital Maximum Grip Strength (MGS) in males and
Dynamometer to inspect correlation between females for right and left hands than forearm
Right Left HC Right FAC Left FAC Right hand Left hand
MGS and other anthropometrical characteristics circumference and BMI. Males have higher body
HC (cm) (cm) (cm) (cm)
MGS (lbs) MGS (lbs)
including BMI, hand circumference, forearm mass index, hand and forearm circumference
BMI 0.625** 0.624** 0.852** 0.833** 0.424* 0.450* circumference. In our research mean maximum and grip-strength than females.
Right HC (cm) 0.995** 0.713** 0.693** 0.768** 0.748** hand-grip strength of participants was Recommendations:
(cm) 83.35±28.355 (lbs) for right hand and
Left HC 0.715 **
0.696 **
0.746 **
0.737 ** As there is no published data available on
(cm) 75.78±27.316 (lbs) for left hand. The mean MGS of present study in Lahore so further studies should
Right FAC 0.995** 0.639** 0.633** both right and left hands in males were be conducted to nd the correlation of MGS and
(cm)
Left FAC 0.629** 0.624** (102.32±13.55, 93.99±13.09) respectively higher other anthropometric variables to support the
Right hand than their counterparts(right48.87±7.99, present study results.
0.961**
MGS (lbs) left42.66±8.29) which is also constant with earlier
References:
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stronger than females. 1- Blackwell JR, Kornatz KW, Heath EM. Effect
Abbreviations HC=Hand circumference, FAC=Forearm circumference, MGS=Maximum grip of grip span on maximal grip force and
strength, BMI=Body mass index. The present study established correlation
between BMI and MGS whereas, moderate fatigue of exor digitorum supercialis.
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tailed). correlation between body mass index and MGS
in males while, correlation was weak between 2- Norman K, Stobäus N, Gonzalez MC,
Discussion: planned to establish the correlation between BMI and MGS in females. The previous studies Schulzke J-D, Pirlich M. Hand grip strength:
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reexamination of patients progress throughout Digital Dynamometer , the anthropometrical BMI and MGS.27 The present study illustrates that Berglund L, Stenvinkel P. Hand-grip muscle
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the management. The current survey was characteristics of healthy individuals in the age correlation between MGS and forearm strength, lean body mass, and plasma

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PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 09

Prevalence of Upper Extremity Musculoskeletal Disorders in Health
Professionals in Lahore
Wazahat Nasir1*, Amber Hassan and Fareeha Amjad1
1
University Institute of Physical Therapy, Faculty of Allied Health Sciences, The University of Lahore,
Pakistan.
*wazich21@gmail.com
Highlights:
Prevalence of musculoskeletal disorders
among 236 health professionals in Lahore was
evaluated.
through nordic musculoskeletal questionaire.
Upper extremity musculoskeletal pain was
found to be common.
Abstract:
Musculoskeletal disorders are dysfunctions
inuencing muscles, bones, nerves, ligaments,
tendons, joints and peripheral nerves leading to
pain or un-easiness.
Objective:
The main objective of the study was to nd out
the prevalence of musculoskeletal problems
among health professionals in Lahore.
Methodology:
In this study, 236 health related professionals
participated including 110 males and 126
females. Data were collected by taking written
information consent form through Nordic
musculoskeletal questionnaire. Data were
analyzed through SPSS version 21.0.
Results:
Out of 236 subjects, prevalence of pain in neck
was 157 (66.5%), shoulder 119 (50.4%), upper
back 106 (44.9%), elbow 30 (12.7%), hand and
wrist 58 (24.6%). Result showed that 127 (53.8%)
participant had sitting posture, 2 (8%) had
squatting posture and 1 (4%) had kneeling
posture and those participants having standing
posture were 106 (44.9%).
Conclusions:
This study concluded that upper extremity
musculoskeletal pain is common in health
professionals depending upon their working
posture.
Keywords:
Musculoskeletal disorders, upper extremity,
health professionals.
Introduction:
Musculoskeletal disorders (MSDs) are
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Nasir W et al., Musculoskeletal Disorders in Health Professionals
therefore, decided to conduct an investigation Table 2 shows the frequency of their posture
among all categories of hospital personnel and during work, 127 (53.8%) had sitting posture, 2
6
on all related disorders. (8%) were having Squatting posture , 1 (4%) had
The purpose of the study was to nd out the kneeling and 106 (44.9%) had standing posture.
prevalence of MSDs in upper extremity in health (Table 2).
professionals making them aware in future of the
Ergonomic
risk factors and to evaluate how much these Frequency Percentage
posture
provocative and retroactive conditions affecting disorders are affecting their activities of daily Sitting 127 53.8%
different body parts. MSD are conditions that are living, social life and professional carrier. This
evaluation helps to identify underlying causes or Squatting 2 8%
slowly produced from work-related activity.
adopt life style changes so that opportunities for Kneeling 1 4%
Three key risk factors associated with these
disorders are analyzed as repetitive movements, disorders and health professionals can be better Standing 106 44.9%
awkward positions and high strength levels.
1 adapted to stressful occupation in favor of Total 236 100%
MSDs include a wide range of progressive and themselves and patients in general.
Methodology: Table 2: Descriptive statistics of ergonomic
regressive problems especially muscular pain, posture
tendonitis and occlusion syndrome. This kind of A cross sectional study design was designed.
profession can affect the occurrence of these Data were collected through convenient Table 3 shows the frequencies of subjects who
diseases, but the increased incidence has been sampling from 236 health professionals. Data had no neck trouble in past 12 months was 79
found in various types of health care workers were collected in 4 months. Both male and female (33.5%), those who had neck trouble during
such as nurses, nursing assistants, X-ray health professionals between the ages of 20 to 62 work was 157 (66.5%). The frequencies of
2
specialists, patient care staff and doctors. The years and the data was collected from different subjects who had no shoulder trouble in past 12
work activities including repetition, contact hospitals of Lahore were included, whereas non months was 117 (49.6%), those who had shoulder
stress, critical positions, lifting, transferring responsive health professionals and with body trouble during work was 119 (50.4%), without
patients and sustained attitude have been trauma of upper extremity were excluded. In elbow trouble during work was 206 (87.3%),
associated with increased risk of MSD. The demographic data age and gender was those who had elbow trouble was 30 (12.7%). The
majority of hospital orders in tertiary care documented. Among 236 health professionals frequencies of participants who had no
facilities provide a wide range of tasks related to participated in the survey including 110 males wrist/hand trouble in past 12 months was 178
repeated manual patient care activities.
3
and 126 females. Data were collected through (75.4%), those who had wrist/ hand trouble was
According to the Bureau of Labor Statistics, Nordic scale questionnaire as it was the 58 (24.6%). The frequencies of subjects who had
work-related structural musculoskeletal convenient and appropriate way for data no upper back trouble in past 12 months was 130
disorders affect nearly one million workers in the collection. Data were analyzed through SPSS (55.1%), and those who had trouble in upper
United States alone each year. This can affect the version 21.0 and graphs were formulated back was 106 (44.9%) (Table 3).
ability of workers to perform the necessary afterwards which made it easy to nd out the
professional activities, which may negatively exact number of health professionals suffering Region Frequency Percentage
affect productivity. It is estimated that economic from musculoskeletal disorders in upper No 79 33.5%
losses from these services in Korea is about US $ 1 extremity. Neck Yes 157 66.5%
billion. Studies have revealed that health care Results: Total 236 100 %
professionals are sensitive to these disorders Table 1 shows the frequency of male and females No 117 49.6%
during routine work. In the health care sector, a that participated in study. A total of 236 subjects Shoulder Yes 119 50.4%
participated with 110 (46.6%) males and 126 Total 236 100%
wide range of workers are affected by them, but
No 206 87.3%
it seems to be a mandatory problem for medical (53.3%) females in this study.
Elbow Yes 30 12.7%
4
practitioners. It has been shown that different Total 236 100%
groups of individual, physical and psychosocial Gender Frequency Percentage
5 No 130 55.1%
factors are predisposed to MSDs. The Upper
Yes 106 44.9%
prevalence ranges from 43% to 78%. Most of the Male 110 46.6% back
Total 236 100%
previous studies have achieved the prevalence of No 178 75.4%
Female 126 53.4%
MSDs through one category of hospital staff Wrist /
Yes 58 24.6%
hand
(nurses, nursing assistants, operating theater Total 236 100% Total 236 100%
nurses, physical therapists, midwives, students, Table 3: Frequency of Musculoskeletal Pain in
secretaries, workers) or through one type of Table 1: Frequency distribution of gender Different Regions
injury (neck pain, shoulder pain). It was
10 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 11
 Nasir W et al.,
Discussion:
In New South Wales and Australian dentists, the
study was conducted which showed that 64%
had different type of pain in the last 12 months.
Southern Thailand study showed that 78%
dentist had musculoskeletal pain in the last 12
months and 78% female staff. A study of dental
hygienists in the United States reported
that approximately 93% experienced
musculoskeletal sign in the previous 12 months.
In a study of Swedish female labor, the dentists
who had wrist and hand pain since last 12
months was 64% which was compared with 54%
of dentists and 27% of dental assistants. Wrist
and hand was the most extreme sign of pain
(69.5%) in an Musculoskeletal disorder study of
dentists in the United States.7 According to our
study, the frequencies of participants who had
neck trouble during work were 157(66.5%). More
than 50% of the nurses (55%) reported that they
had multiple disorders in their body. Of the 347
nurses selected, 317 lled the questionnaires
(91%).The total age and time period of work as a
nurse was 33.7 (7.7%) years and 10 (7.6%) years
respectively.8 According to our study, a total
number of 236 subjects participated in lling
questionnaires including 110 (46.6%) males and
126 (53.3%) females. A whole medical
assessment of the cases show that upper
extremity (38.7%) was the highest main region
for pain. The severity of pain to muscular skeletal
disorder percentage was calculated as medium
and high in 42.9 cases and as low in 23.2 cases.
67.9% of the study showed anxiety and 28.6%
9
show depression. According to our study, the
frequencies of participants of how much work
they perform per day 1-4 hours was 9 (3.8%), 5-8
hours per day was 69 (29.2%), 9-12 hours per day
was 134 (56.8%), 12 and above was 24 (10.2%).
95% of nurses had symptoms in last 12 months.
The frequency of dentists who suffered from
pain in neck region, shoulder, upper back region,
wrist and hand, arms / forearms were 48.8%,
27.3%, 14.7%, 9.3%, 6% respectively. The 18%
dentists did not claimed any pain in the past 6
months. Work-related stress was the most
frequent problem related to mental health
represented by 57.6%, fatigue (38%), waking late
night (8%), and depression before going to work
(7.3%), the level of anxiety (5.3%) and the level of
nervousness (3.3%).10 According to our study the
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Musculoskeletal Disorders in Health Professionals Nasir W et al., Musculoskeletal Disorders in Health Professionals
frequencies of participants who suffered from 6- Jellad A, Lajili H, Boudokhane S, Migaou H,
neck, shoulder, elbow, upper back and Maatallah S, Frih ZBS. Musculoskeletal
wrist/hand were 66.5%, 50.4%, 12.7%, 44.9% and disorders among Tunisian hospital staff:
24.6%. Prevalence and risk factors. The Egyptian
Conclusions: Rheumatologist. 2013;35(2):59-63.
This study concluded that musculoskeletal 7- Hayes M, Cockrell D, Smith D. A systematic
disorder (MSD) is a common disorder among review of musculoskeletal disorders among
health professionals. Upper extremity dental professionals. International journal of
musculoskeletal disorders prevalence in health dental hygiene. 2009;7(3):159-65.
professionals is relatively high depending upon
their working posture. 8- Mehrdad R, Dennerlein JT, Haghighat M,
Recommendations: Aminian O. Association between
Most of the previous literature was descriptive psychosocial factors and musculoskeletal
cross-sectional surveys. Further studies were symptoms among Iranian nurses. American
recommended to carry out on a large sample size journal of industrial medicine.
to identify etiology and risk factors of 2010;53(10):1032-9.
musculoskeletal disorder 9- Del Campo M, Romo PE, de la Hoz RE,
References: Villamor JM, Mahíllo-Fernández I. Anxiety
1- Nkhata LA, Esterhuizen TM, Siziya S, Phiri and depression predict musculoskeletal
PD, Munalula-Nkandu E, Shula H. The disorders in health care workers. Archives of
Prevalence and Perceived Contributing environmental & occupational health.
Factors for Work-Related Musculoskeletal 2017;72(1):39-44.
Disorders Among Nurses at the University
10- Kaul R, Shilpa P, Sanjay C. Musculoskeletal
Teaching Hospital in Lusaka, Zambia.
disorders and mental health related issues as
Science. 2015;3(4):508-13.
occupational hazards among dental
2- Del Campo M, Romo PE, de la Hoz RE, practitioners in the city of Bengaluru: a
Villamor JM, Mahíllo-Fernández I. Anxiety randomized cross-sectional study. 2015.
and depression predict musculoskeletal
disorders in health care workers. Archives of
environmental & occupational health.
2017;72(1):39-44.
3- C H A N C H A I W , S O N G K H A M W ,
KETSOMPORN P, SAPPAKITCHANCHAI
P, SIRIWONG W. Prevalence and factors
associated with musculoskeletal disorders
among Thai hospital orderlies. International
Journal of Occupational Hygiene.
2015;7(3):132-8.
4- Das SK, Mukhopadhyay S. Effect of altered
body composition on musculoskeletal
disorders in medical practitioners. Int J Res
Eng Tech. 2016;5.
5- Mehrdad R, Dennerlein JT, Haghighat M,
Aminian O. Association between
psychosocial factors and musculoskeletal
symptoms among Iranian nurses. American
journal of industrial medicine.
2010;53(10):1032-9.
12 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 13

Correlation Between Level Of Depression, Sleep Disturbance And Suicidal
Thoughts Among Lower Limb Amputees
Anna Zaheer1*, Faiza Sharif1, Nida Fatima1, Ayesha Shaque1 and Zeeshan Khan1
1
University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
*annazaheer@yahoo.com
Highlights:
Current study is a cross sectional survey to find level
of depression and its correlation with sleep and
suicidal thoughts among lower limb amputees.
Patient health questionnaire-9 (PHQ-9) was used
and data was calculated from registered hospitals and
rehabilitation centers in Lahore, Pakistan.
It was concluded that amputees suffered from
depression of varying severities and there was a
significant correlation between depression, sleep and
suicidal thoughts.
Abstract:
Amputation is an operative removal of a
particular part of the body. Types of this surgical
process vary from patient to patient depending
upon the condition of a patient. Amputees face
various psychological consequences which may
lead to depression.
Objective:
To nd the correlation between sleep, suicidal
thoughts and depression among lower limb
amputees.
Methodology:
It was a cross sectional survey conducted on
amputees. Data were collected from registered
government hospitals and rehabilitation centers
of Lahore, Pakistan. Modied Patient Health
Questionnaire (PHQ-9) was used to nd
frequency score of depression. Patient with
Transtibial and transfemoral amputation were
included in the study. People with other
disabilities, pregnancy, infectious stump, upper
motor disease, lower motor disease and ongoing
malignancy were excluded.
Results:
This study was conducted on 70 patients with
Lower limb amputation that was either trans-
tibial or trans-femoral. Among all participants
53(75.7%) were males and 17(24.3%) were
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
females. Depression was presented in 55
(78.57%) amputees, among those 21 (30%)
participants were suffering from mild
depression, 20 (28.6%) from moderate, 12 (17.1%)
with moderately severe and only 2 (2.9%)
participants were presented with severe
depression. Correlation of depression score with
sleep disturbance was 0.492( p 0.000) and that of
depression score and frequency of suicidal
thought was 0.452 (p 0.000).
Conclusions:
Patients who underwent amputation suffered
from various psychological consequences such
as depression. They had sleep disturbances and
suicidal thoughts found to be directly associated
to depression.
Key words:
Amputees, Depression, Suicidal thoughts.
Introduction:
Amputation is an operative removal of a
particular part of the body. Types of this surgical
process vary from patient to patient depending
upon the condition of a patient. Amputation is
the last hope of survival for patients suffering
from different pathological condition. The
1
unilateral or bilateral amputation may be
performed and are divided in minor or major
amputation. Minor part of limb removal like toe
etc. are included in minor amputation and full
and partial limb removal is called major
amputation.2 Most commonly performed were
transfemoral and trans-tibial. Peripheral artery
disease is the second major cause of amputation
3
in developed countries. Lower Limb
Amputations for peripheral arterial disease were
performed predominantly on an elderly people
with concomitant medical complications and
4
poor social support. Lower Limb Amputation
(LLA) because of trauma was seen in young
individuals in road trafc accidents. More
proximal the amputation is, fewer chances to
regain ambulation are present, above knee
amputation is preferable for those where below
knees amputation is not suitable which might be
14
Zaheer A et al.
due to decreased blood supply to distal portion
of the limb or other causes.5 Amputees also face
various psychological consequences which may
lead to depression.6 This stigma is one of the
major problems of person undergoing
amputations as it may leads to social pressure
and non-acceptability. 7 Experience of depression
varies person to person. Amputation is a strong
enough to causes anxiety and negative thoughts
in amputee which can be related to psychological
issues. 6 This situation can be worsened by lack of
social support, self-consciousness of disability
and knowledge which are among common
reasons of psychological disorders. Functional
limitation due to amputation can lead to
joblessness of the survivor which directly causes
nancial and social troubles leading to poor
psychological condition of that person. This can
lead to social isolation due to reduced self-
esteem and lack of condence to face people in
presence of disability.8 Before getting prosthesis,
during the trial and after the adjustment to
prosthesis, physiotherapist plays a signicant
role in rehabilitation process. Standing for the
rst time after amputation require prior
functional independence by physiotherapy
sessions, this will decrease the chance of falling
and thus fear of fall. This will help in decreasing
9
depression and boast self-esteem. The amputees
have a huge number of psychosocial issues
which need to be addressed in order to provide a
holistic approach and a better life. It is essential
to aware the patient's family, the health care
providers and community to the additional
10
psychosocial requirements of amputees. Proper
physiotherapy along with the multidisciplinary
approach in coordination with other
rehabilitation departments can result in
11
improvement. While treating amputees, it
should always be kept in mind that the focus
should not only be limited to the physical need of
a patient but it is compulsory to consider other
parameters like social, emotional and nancial
factors so we can provide a complete and better
rehabilitation.12 The purpose of this study was to
nd the correlation between sleep, suicidal
thoughts and depression among lower limb
amputees. This study benets in a way that it can
direct further studies to accommodate the
amputees in rehabilitation centers with not only
physical rehabilitation but also on psychological
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Sleep, Pain & Level of Depression in Lower Limb Amputees
counseling for their better physical and mental
health. Most of the previous studies were cross-
sectional and no good prospective data was
present on depression among lower amputees
according to researcher's knowledge, this is
needed to be addressed in future studies.
Methodology:
It was a cross sectional survey conducted on
amputees. Sample size was 70. This study was
conducted on Lower limb amputees that were
either trans-tibial or trans-femoral. Data were
collected from registered government hospitals
(Mayo Hospital, Jinnah Hospital) and
Rehabilitation center (Pakistan Society of
Rehabilitation of Disable) of Lahore, Pakistan.
Patient Health Questionnaire (PHQ-9) was used
to nd the frequency and level of depression.13
Patient with transtibial and transfemoral
amputation between age 18 to 60 years were
included in the study. People with other
disabilities, pregnancy, infectious stump, upper
motor disease, lower motor disease and ongoing
malignancy and age less than 18 years were
excluded. Data were analyzed statistically using
SPSS version 22.0.
Results:
70 lower limb amputees were included in this
study, among those 53(76%) were males and
17(24%)were females (Figure 1).
Female, 17, Male
24%
Female
Male, 53,
76%
Figure 1: Frequency of gender of participants
Results showed that 15 out of 70 participants
were not suffering from depression whereas
55(78.57%) amputees had depression, amongst
those 21(30%) amputees had mild depression,
20(28.6%) participants had moderate, 12(17.1%)
were presented with moderately severe and only
2(2.9%) participants were suffering from severe
depression (Figure 2).
15
 Zaheer A et al.
Figure 2: Level of depression among participants
A signicant correlation between sleep
disturbance and suicidal thoughts with
depression in lower limb amputee was found
(Table 1). Depression score of individual
participants was calculated using statistical
analysis. Correlation of depression score with
sleep disturbance was 0.492(p 0.000) and
correlation of depression score and frequency of
suicidal thought is 0.452(p 0.000).
As p value is 0.000 (less than 0.05) so it showed
that sleep disturbance and suicidal thoughts had
direct relation with frequency of depression.
Depression score
0.496 *
Sleep disturbance
0.452*
Frequency of suicidal thoughts
Table 1: Correlation of depression score with
sleep disturbance and suicidal thoughts
Discussion:
Amputation may lead to various psychological
issues. Hawamdeh ZM et al., conducted a
research on amputees and concluded that 20% of
56 participants had depressive symptoms.
Patients were recruited from clinics of Jordan
University hospital, and Al-Basheer hospital in
Amman Royal Farah Rehabilitation Center,
14
Jordan . Majority of the responders had mild
depression whereas very few were severely
depressed this may be due to the reason that with
the time patients start excepting their bodies,
gradually they accept the change in their life due
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Sleep, Pain & Level of Depression in Lower Limb Amputees
to amputation and start adapting to it. In a
systematic review conducted in India by Sahu E
et al., it was indicated that depression and other
stress related conditions gradually decreases
15
with time . Singh R et al., conducted a cohort
study in which depression was screened in 105
amputees in rehabilitation ward. It was reported
that 28(26.7%) patients had symptoms of
depression and other psychological issues were
16
also present in those participants . Participants
reported that they had trouble sleeping which
was signicantly correlated to their depression.
Those having sleep disturbance were depressed
which negatively Affect not only their
rehabilitation but also their social life.
Amputation is a serious tragedy in a person's life
which can make a person psychologically
unstable that he could have suicidal thoughts
which directly indicates presense of depression
in that person. People having traumatic
amputation suffered from more depression and
anxiousness as their pre-amputation time of life
could be much better than people already had
physical problems and disorders such as
diabetes mellitus, which is common cause of
amputation in Pakistan and it has several
17
adverse effects on body . In previous studies
p value
such as in a study conducted by Sing et al., it was
0.000 indicated that incidence of depression after
amputation varies with time. Sometimes,
incidence of depression could be 17.6 and 19.1%
which was comparable to majority of previous
0.000
studies but occasionally it could be as high as
41% or much higher rate18. Frierson RL and et al.,
in their study explained that psychological
issues found in amputees have by far received
very poor attention. Patients undergone an
amputation process not only suffer from a
physical loss but it can also takes away various
parameters of an individual's life having a major
impact on their future life. It is also known that
amputees themselves do not focus on psychiatric
consultation without psychiatric referral
prescribed by any health care provider. Ideally,
such life-event stressors are best handled with
psychiatric referral. The psychological referral is
compulsory in such cases because of various
reasons, some of which are behavior problems,
ashbacks of previous accidental events,
suicidal thoughts and unable to accept body
16
Zaheer A et al.
appearance etc. Moreover, psychiatric
consultation can slightly lessen ICU and clinic
stays and also promote better behavior and
relation with family and friends which directly
improve social support and thus improving
overall mental and physical health 19.
Conclusions:
The patients who underwent amputation
suffered from various psychological
consequences such as depression. They had
sleep disturbance and suicidal thoughts which
were directly associated to depression. The
psychological referral is compulsory in such
cases because of various psychological reasons to
provide holistic care.
Recommendations:
Most of the studies were cross-sectional and no
g oo d p r osp e c t i v e d a t a w a s p r e se n t on
depression among lower amputees according to
researcher's knowledge, this is needed to be
address in future studies.
References:
1- Sadeghifard V. Causes and types of
amputation from occupational trauma in
patients referred to Fatemi hospital in
Ardabil city, 2011. journal of health.
2014;5(3):235-9.
2- Columbo JA, Davies L, Kang R, Barnes JA,
Leinweber KA, Suckow BD, et al. IP183.
Patient Experience of Early and Late
Recovery After Major Leg Amputation for
Arterial Disease. Journal of Vascular Surgery.
2017;65(6):104S-5S.
3- Saraf A, Gupta A, Prakash JS, Prakash JS.
Effect of Postoperative Ambulation on the
Quality of Life in a Transtibial Amputee.
Indian Journal of Physiotherapy and
Occupational Therapy. 2013;7(3):109.
4- Davie-Smith F, Coulter E, Kennon B, Wyke S,
Paul L. Factors inuencing quality of life
following lower limb amputation for
peripheral arterial occlusive disease: a
systematic review of the literature.
Prosthetics and orthotics international.
2017;41(6):537-47.
5- Hosn MSA. Above-Knee Amputation.
Operative Dictations in General and Vascular
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Sleep, Pain & Level of Depression in Lower Limb Amputees
Surgery: Springer; 2012. p. 992-5.
6- M c k e c h n i e P , J o h n A . A n x i e t y a n d
depression following traumatic limb
amputation: a systematic review. Injury.
2014;45(12):1859-66.
7- Czerniecki JM, Turner AP, Williams RM,
Hakimi KN, Norvell DC. The effect of
rehabilitation in a comprehensive inpatient
rehabilitation unit on mobility outcome after
dysvascular lower extremity amputation.
Archives of physical medicine and
rehabilitation. 2012;93(8):1384-91.
8- Mozumdar A, Roy SK. Depression in adult
males with lower extremity amputation and
its bio-social correlates. Health.
2010;2(08):878.
9- Hordacre B, Birks V, Quinn S, Barr C, Patritti
BL, Crotty M. Physiotherapy Rehabilitation
for Individuals with Lower Limb
Amputation: A 15 Year Clinical Series.
Physiotherapy Research International.
2013;18(2):70-80.
10- Sinha R, van den Heuvel WJ, Arokiasamy P.
Factors affecting quality of life in lower limb
amputees. Prosthetics and orthotics
international. 2011;35(1):90-6.
11- Marshall C, Stansby G. Amputation. Surgery
(Oxford). 2008;26(1):21-4.
12- Belon HP, Vigoda DF. Emotional adaptation
to limb loss. Physical medicine and
rehabilitation clinics of North America.
2014;25(1):53-74.
13- Kocalevent R-D, Hinz A, Brähler E.
Standardization of the depression screener
patient health questionnaire (PHQ-9) in the
general population. General hospital
psychiatry. 2013;35(5):551-5.
14- Hawamdeh ZM, Othman YS, Ibrahim AI.
Assessment of anxiety and depression after
lower limb amputation in Jordanian patients.
Neuropsychiatric disease and treatment.
2008;4(3):627.
15- Sahu A, Sagar R, Sarkar S, Sagar S.
Psychological effects of amputation: A
review of studies from India. Industrial
psychiatry journal. 2016;25(1):4.
17
 Zaheer A et al.
16- Singh R, Hunter J, Philip A. The rapid
resolution of depression and anxiety
symptoms after lower limb amputation.
Clinical rehabilitation. 2007;21(8):754-9.
17- Zuberi SI, Syed EU, Bhatti JA. Association of
depression with treatment outcomes in Type
2 Diabetes Mellitus: A cross-sectional study
from Karachi, Pakistan. BMC psychiatry.
2011;11(1):27.
18- Singh R, Ripley D, Pentland B, Todd I, Hunter
J, Hutton L, et al. Depression and anxiety
symptoms after lower limb amputation: the
rise and fall. Clinical rehabilitation.
2009;23(3):281-6.
19- Frierson RL, Lippmann SB. Psychiatric
consultation for acute amputees: Report of a
ten-year experience. Psychosomatics.
1987;28(4):183-9.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Sleep, Pain & Level of Depression in Lower Limb Amputees
18
The Effect of Shoulder Position on Hand Grip Strength among
University Students
1 1
Babar Bashir *, Arooj Ashfaq and Maryam Altaf
1
University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
*babarawan401@gmail.com
Highlights:
Shoulder position affect the hand grip strength
There is a statistically signicant difference
present between hand grip strength
measurements of both the genders.
There is strong positive correlation present
between most of the shoulder movements.
Abstract:
Hand grip-strength evaluation is an important
variable for assessment of upper extremity
deformities. Many studies have observed hand
grip-strength in different positions and postures
but no importance on further resulting positions
that are being utilized in our clinical setups.
Objective:
To evaluate the effect of shoulder position on
hand grip strength among university students.
Methodology:
42 (22 males, 20 females) physically healthy and
active individuals 22.76 ± 1.96 years old were
involved in this study. Study design was cross
sectional. Hand grip-strength (kg) using hand
grip dynamometer (Jamar dynamometer) was
measured in three different positions of shoulder
joint after obtaining informed consent.
Participants were requested to carry out ve
seconds maximum contractions in each position.
Position of wrist was kept neutral i.e. 0°
Participants were requested to stand with wider
base and to increase further stability they were
made to stand with the wall behind them. Both
right and left hands were tested three times in
every position. At the end average was
calculated from 3 values and 60 seconds rest
interval was also given to the participants.
Results:
Participants with no previous history of
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
showed that mean right neutral shoulder
rotation value of male participants was 77.18 ±
19.23 whereas mean right neutral shoulder
rotation value of female participants was 20.20 ±
7.34 kilograms where p-value is <0.001 which
showed the presence of statistically signicant
difference between both the genders. Pearson
correlation stated that very strong positive
correlation (r= 0.960) was present between right
neutral shoulder rotation and 90° shoulder
abduction in males.
Conclusions:
Shoulder positions affect hand grip strength.
There is signicant difference present between
both the genders and presence of positive
correlation has been recorded in shoulder
positions which states that shoulder positions
affect hand grip strength.
Key Words:
Hand Grip Strength, Healthy Population,
Shoulder positions, Hand Grip Dynamometer.
Introduction:
Grip strength is an indicator of several necessary
parameters that include energy, nourishment,
1,2
debility and reduced activity. Thus, Grip
Strength (GS) measure necessarily contributes
in screening for individuals that may have the
benet of avoidance or early intercession
protocol and observation for more diminution.2, 3
These three positions are handy and can be
utilized to evaluate GS: Neutral shoulder
rotation, 90° shoulder abduction and 90°
strength involving leading as well as non-
dominant extremities. According to studies a
usual hand grip activity in a disinterested
position triggered some muscle groups;
infraspinatus and supraspinatus.4 GS is being
correlative with the upper extremity strength
19
 Bashir B et al. Shoulder Position & Hand Grip Strength Bashir B et al. Shoulder Position & Hand Grip Strength

5
and overall body strength , at the same time as a evaluation of HGS assists the researchers create contraction to avoid fatigue. Right 90
degree
Right 90
degree
Left
neutral
Left 90
degree
Left 90
degree
6 1 9 Gender shoulder shoulder
shoulder shoulder shoulder
quantitative measure of upper limb action. GS is sensible management objective. Results: abduction
abduction
and ER rotation abduction
abduction
and ER

extensively considered just as a forecaster of Alizadehkhaiyat et al., proposed in his study that Mean age of participants was 22.76 ± 1.96 years Male
Right neutral
shoulder rotation 0.960** 0.873** 0.449 * .501* 0.507
7
purposeful performance and it is inuenced by a consistent hand-grip movement in and mean weight of participants was 68.83±15.17 Right 90 degree
.881** .521* .547** .536**
shoulder abduction
various factors that include hand dominance, disinterested position increased the activity of kilograms. Independent t test revealed that there Right 90 degree
shoulder abduction .435* .470* .417**
anthropometric indices8 and positions of the GS correlated with upper extremity strength4. was a statistically signicant difference present and ER
Left neutral
9 10 11 .877** .848*
elbow , shoulder , as well as forearm. Hand grip Julia-Ann Lee et al., carried out a study on how between both genders. The results indicated the shoulder rotation

Left 90 degree
dynamometers have been made known as a GS is affected by wrist positions. According to presence of very strong correlation between shoulder abduction .822*

precise and dependable for estimating GS and this study the maximum GS at the neutral Right hand neutral shoulder rotation and 90°
12, 13 Table 2: Pearson correlation
they are user friendly. GS measurement is of position of wrist is considerably greater than all abduction of right shoulder in males and a strong
use in evaluation of those individuals who other ve positions of interest.20 The objective of correlation was seen between right neutral Pearson correlation stated that strong correlation
experience detriments in their everyday life this research was to observe the HGS values shoulder rotation and 90° abduction and was found between right neutral shoulder
activities, measure of upper extremity function, acquired from three different testing positions external rotation of right shoulder. There was rotation and right 90° shoulder abduction in
and efciency of hand rehablitation procedures.14 and how these positions signicantly affect the also a strong correlation present between 90° females
The value of such an alteration is achieved by GS among group of young healthy males and degree shoulder abduction and 90° abduction Right 90 Right 90
degree
Left Left 90 Left 90
degree
degree neutral degree
comparing individual's GS with well-known females and to determine if there are and external rotation of right shoulder. There is a Gender
shoulder
shoulder
abduction shoulder shoulder
shoulder
abduction
abduction and ER rotation abduction and ER
normal values. Many factors inuence GS it is considerable differences for both sexes and for statistically signicant difference between both Right neutral
Female
shoulder rotation 0.775** .666** 0.361 0.371 0.355
very important to evaluate GS in such postures each group in three different testing positions the genders for which independent sample t test Right 90 degree
that are similar to those utilized in standard and to determine association between GS values .564** .168 .27 .159**
was used and there is signicant difference shoulder abduction
15 Right 90 degree
researches. Some studies tested Hand Grip which if present could be employed in found (p value <0.001). shoulder abduction .354 .398 .412**
and ER
Strength (HGS) in two different positions with rehabilitation and other clinical settings to Left neutral
.712** 0.725
elbow joint exed16 or in unusual postures17 but investigate function of shoulder musculature. n Mean
Std.
t-test p-value
shoulder rotation
Gender Left 90 degree
Deviation
they didn't use same organized procedure to Methodology: Male 22 77.18 19.23 12.44
shoulder abduction 0.764
Right neutral shoulder rotation <0.001
evaluate grip in sitting or supine positions. So, 42 physically healthy and active individuals (22 Female 20 20.20 7.34
Table 3: Pearson Correlation
Male 22 75.02 22.13 11.29
the relationship to standard norms can be males, 20 females) were recruited from different Right 90° shoulder abduction <0.001
**. Correlation is signicant at the 0.01 level (2-
Female 20 16.61 6.97
present when arm position is held constant. To Universities of Lahore with no past history of Right 90° shoulder abduction Male 22 68.08 21.92 9.84 tailed).
<0.001
understand when a special individual test can be any kind of upper extremity, shoulder or neck and ER Female 20 16.89 8.11
*. Correlation is signicant at the 0.05 level (2-
Male 22 68.64 13.29 15.61
contrasted with standard examples, we must be injury. HGS using Hand grip dynamometerwas Left neutral shoulder rotation
Female 20 17.06 6.74
<0.001
tailed).
aware of such body positions which provide measured in three different testing positions i.e. Male 22 67.01 15.86 13.3
Left 90° shoulder abduction
Female 20 16.39 6.44
<0.001 Discussion:
comparable GS value and which one of the neutral shoulder rotation, 90 degree shoulder Left 90° shoulder abduction Male 22 64.31 12.65 16.57
<0.001
Previous studies also state that men have
positions provides changed GS value. abduction, 90 degree abduction of shoulder and and ER Female 20 14.98 4.32
increased scores of HGS. It also suggest that
Progression of shoulder muscle's strength is external rotation after obtaining informed Table 1: T-test: Presence of statistically there was lot of variation in scores obtained from
most important outcome of almost every rehab consent. Participants were requested to carry out signicant difference between males and females and it can be seen in this study as well.
exercise course regarding recovery of impaired ve seconds maximum contraction in all these females There may be some other factors that contribute
shoulder function because it plays a major part in positions. Position of wrist was kept neutral i.e. 0
Pearson correlation stated the presence of to variation among females but that need further
shoulder joint's stability. Continuous degree. Participants were requested to stand
positive correlation among each position of research to be done on this topic. Studies also
observation of these variations facilitates with wider base in such a way that feet should be
shoulder. Very strong correlation was present verify that different positions of joints can
researchers to improvise the rehab protocol kept at shoulder width away from each other and 21
between right neutral shoulder rotation and 90° inuence HGS particularly the shoulder joint.
whenever needed and support them, in to increase stability they were made to stand
shoulder abduction in males. As indicated previously in methodology that
formulating conclusions concerning the with wall at the back. Both right and the left participants were asked to perform the HGS task
patients, go back to pre-injured state. Shoulder hands were tested three times in every position in standing position as standing position is
injuries arise often in participant who execute and participants were encouraged verbally to **. Correlation is signicant at the 0.01 level (2- expected to provide the highest scores.
overhead activities at various stages of sports.18 perform maximum contraction. At the end tailed). 22
Preceding studies also agree to this. Preceding
HGS is basic method to evaluate the subject's average was calculated from 3 values. There was *. Correlation is signicant at the 0.05 level (2- studies have stated that gender, age affect
condition after injuries. A precise, scientic a rest time of about 60 seconds between every tailed). the GS when being measured with Jamar

PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 20 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 21
 Bashir B et al.
dynamometer. These conclusions can be
claried by raise of HGS in both genders was
vigorously correlated with varied muscle bulk
throughout their adolescence. In real meaning of
research veries that a variety of joint positions
21
can affect GS particularly the shoulder joint.
With the understanding obtained from current
research specic intervention protocol can be
planned to take care of the patients in a particular
upper extremity functioning.
Conclusions:
Shoulder positions affect HGS. There was very
strong correlation found in right neutral
shoulder rotation and 90° degree shoulder
abduction followed by 90° degree shoulder
abduction and 90° shoulder abduction with
external rotation.
Recommendations:
Upcoming researches are recommended to
observe the results of GS dimensions obtained
with different angles and positions of shoulder
then it may be possible to say that which of the
position affects more. Researchers should be
aware of the effect of different testing positions
on GS evaluation.
References:
1- B o h a n n o n R W . D y n a m o m e t e r
measurements of hand-grip strength predict
multiple outcomes. Perceptual and motor
skills. 2001;93(2):323-8.
2- Bohannon RW. Hand-grip dynamometry
predicts future outcomes in aging adults.
Journal of geriatric physical therapy.
2008;31(1):3-10.
3- Watterson C, Fraser A, Banks M, Isenring E,
Miller M, Silvester C, et al. Evidence based
practice guidelines for the nutritional
management of malnutrition in adult
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Nutrition and Dietetics. 2009;66(s3):S1-S34.
4- Alizadehkhaiyat O, Fisher A, Kemp G,
Vishwanathan K, Frostick S. Shoulder muscle
activation and fatigue during a controlled
forceful hand grip task. Journal of
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Shoulder Position & Hand Grip Strength
Electromyography and Kinesiology.
2011;21(3):478-82.
5- Rantanen T, ERA P, HEIKKINEN E. Maximal
isometric strength and mobility among 75-
year-old men and women. Age and ageing.
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6- Balogun JA, Akomolafe CT, Amusa LO. Grip
strength: effects of testing posture and elbow
position. Archives of physical medicine and
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Gardin L, Giordano S, Tappero R. Handgrip
strength is an independent predictor of
functional outcome in hip-fracture women: a
prospective study with 6-month follow-up.
Medicine. 2015;94(6).
8- Massy-Westropp N, Rankin W, Ahern M,
Krishnan J, Hearn TC. Measuring grip
strength in normal adults: Reference ranges
and a comparison of electronic and hydraulic
instruments 1. The Journal of hand surgery.
2004;29(3):514-9.
9- KHAN AA, KHAN Z, MUKARRAM M.
Effect of elbow ection on grip strength in
vertical and horizontal directions. Journal of
human ergology. 2013;42(1_2):13-22
10- Su C-Y, Lin J-H, Chien T-H, Cheng K-F, Sung
Y-T. Grip strength: relationship to shoulder
position in normal subjects. Gaoxiong yi xue
ke xue za zhi. The Kaohsiung journal of
medical sciences. 1993;9(7):385-91.
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forearm rotation on grip strength. Age
(years). 1998;22:22.90.
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transmission: muscle relative position and
length determine agonist and synergist
muscle force. Journal of Applied Physiology.
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13- Mathiowetz V. Reliability and validity of
hand strength evaluation. J Hand Surg.
1984;10:321-7.
22
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Neal K, Rowlands B, et al. A practical posture
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Weber K, Dowe M, Rogers S. Grip and pinch
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PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 23

Awareness & Attitude Towards Physical Activity Among Pediatric
Population in Pakistan
1 1
Muhammad Jawad *, Fahad Tanveer , Wardah Rauf and Haz Zain Pervaiz
1 diabetes and other metabolic disorders,
University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
2
Department of Quantitative Methods, University of Management and Technology ,Lahore, Pakistan
*m.j.00786@gmail.com
Highlights:
Lack of awareness and inactive attitude
towards physical activity is concluded.
Awareness and attitude towards physical
activity among pediatric population in Pakistan
was determined.
Awareness of healthy lifestyles by promoting
physical activity may be addressed by this study.
Abstract:
The importance of Physical Activity (PA) and its
benecial outcomes regarding health are well
known facts. Modernization of the world has
strong impact on lifestyles and behaviors of all
individuals falling in different age groups.
Children start learning routine activities in early
childhood that turns into their habits in
adulthood.
Objective:
This study aimed to determine awareness and
attitude towards physical activity among
pediatric population in Pakistan.
Methodology:
Total 62 children participated in this study from
two institutes of Lahore, Pakistan having age 5-
12 years. Subjective measures (self-report) and
objective measures (pedometer steps) were
collected through Children Physical Activity
Questionnaire (C-PAQ) and analyzed
statistically.
Results:
The results showed that mean time spent in hard
PA among girls was 99.66±138.32minutes and
among boys was 213.18±182.41minutes (p-value
0.008). Mean time spent in moderate PA among
girls was 110.69±77.16minutes and among boys
was 188.33±119.70minutes (p-value 0.004). Mean
time for T.V/homework etc. among girls was
752.76±424.53minutes and among boys was
925.15±451.04minutes (p-value 0.128). There was
inverse and weak relationship between age and
C-PAQ score (r=0.097). There was positive and
weak relationship between pedometer steps and
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
1
2
time spent in PA (r-0.237).
Conclusions:
There is lack of awareness towards PA among
pediatric population in Pakistan. Mostly
children overestimate their level of PA. They
failed to achieve the required level of PA. Boys
are found to be more active than girls. They spent
more time in sports, videogames, computer etc.
as compared to girls while girls spent more time
in leisure activities and homework. PA level
tends to decrease by increasing age and there is
irregular and miscellaneous attitude towards
PA.
Keywords:
Awareness, Attitude, Physical activity, Pediatric
population.
Introduction:
Sedentary Behaviors (SB) are dened as a
distinct class of behaviors characterized by little
physical movement and low energy expenditure
1
(≤1.5 METs). Sedentary lifestyles such as sitting
at work, school or while regular travelling via car
or bus, watching television, reading, using a
computer, and playing video games2 are
progressively causing risk of NCDs including
Cardio Vascular Diseases (CVDs), Reduced Bone
Mineral Density (BMD), obesity, diabetes
mellitus, cancers, osteoporosis, chronic
respiratory diseases, and psychological
disorders3-5 that constitute a major challenge
towards public health and clinical medicine all
6 video games (AVGs)/virtual reality (VR) games
over the world.
Pakistan, 6th most populous country on the
globe, carries 40 million population suffering
from high blood pressure, cardiac disease;32
million, obesity;24 million, high cholesterol;18
million, diabetes;8 million and mental health
disorders;50 million.7
Physical Activity (PA) is dened as any bodily
movement produced by skeletal muscles that
require energy expenditure.8 PA aids to build
muscle mass during development and conserve
musculoskeletal function during aging,
stimulates cardio-metabolic wellness, improves
24
Jawad M et al.,
cognitive skills, and prociently supports in the
prevention and treatment of a variant health
conditions, including cardiovascular disease,
osteoporosis, cancer and abatement in the
symptoms of mental illness, and renements in
self-condence and self-esteem.9,10 According to
WHO, in Pakistan the country with inequalities
regarding to quintiles of socioeconomic status11,
required level of public education and
awareness campaigns on PA is not achieved yet.12
Physically active lifestyle starts developing very
early in childhood and the habits of moderate or
high level PAs continue along the life course
from youth to adulthood. For childhood based
positive health benets, minimum 60 min of
13
MVPA per day is recommended. Modern
lifestyles are affected by social, cultural and
14
technological changes. Family environment
and factors such as access to media
(TV/internet), household rules, siblings
inuences and habits, were noted to be
signicant in impacts on children's sedentary
and active behaviors.15 School settings are
trending towards devoting more teaching time
to academics, which reduces time spent in
16
physical education and sport in schools.
It is notable that traditional organized games do
not meet required MVPA levels and have more
sedentary lifestyle, in comparison to free play.
However, both modied using LET US Play
principles (optimizing MVPA by modifying
games), increases the amount of MVPA time and
17
SB among boys and girls is remarkably reduced.
Probably, parks and green areas occurs to play
vital role that serves options for a wide range PA
behaviors, like recreational walking and playing
18
sports. Latest researches also support the active
being helpful to engage the children in sufcient
PA intensity and reduce SB for positive health
benets.19
Methodology:
The cross sectional study was conducted in two
different schools of Lahore, Pakistan in 2018
among pediatric population (age 5 to 12).
Convenient sampling was used to get data of 62
children (boys=33 and girls=29) via subjective
measures (self-reported) and objective measures
(pedometer). Children Physical Activity
Questionnaire (C-PAQ) was used to determin
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Physical Activity Among Pediatric Population
e the attitude towards PA and Modied SHAPES
Questionnaire for Children to access the
awareness about PA were used for subjective
measures. Validity and reliability of C-PAQ and
Modied SHAPES Questionnaire for children
were evidenced20,21.
C-PAQ was presented to the parents on sunday
and asked to recall their child's activities for the
past seven days. Modied SHAPES
Questionnaire was distributed among children
on Thursday to estimate the time spent in hard
PAs, moderate PAs and watching T.V/playing
video games/doing homework etc. for four days
(Thursday-Sunday). Phisiopadic LCD
pedometers were attached to the children for
objective measures. With proper instruction,
children were guided to wear it four days all the
time except sleeping, bathing or any water
activity to avoid any damage. Pedometers were
set to zero count, sealed in waist band pouch and
aligned to right side to get accurate
measurement. C-PAQ was scored according to
level of PA. High energy level PAs were scored
as 5, moderate level PAs were scored as 3 and
low level PAs were scored as 1 while 0 for not
activity. C-PAQ results were calculated in
percentage.
Results:
Average time for hard PAs among Girls was
99.66±138.32minutes and among boys was
213.18±182.41minutes (p-value 0.008). Average
time for moderate PAs among Girls was
110.69±77.16 minutes and among Boys was
188.33±119.70minutes (p-value 0.004). Average
time for T.V/Games etc. among Girls was
752.76±424.53minutes and among Boys was
925.15±451.04 minutes (p-value 0.128). Boys and
girls obtained mean score in C-PAQ was
40.48±12.45% and 34.24±8.41% respectively
(p=0.026). Mean pedometer steps count for boys
was 8874.52±1333.47 and 8305.48±1149.44 for
girls.
25
 Jawad M et al., Physical Activity Among Pediatric Population Jawad M et al., Physical Activity Among Pediatric Population

.24
Gend Std. steps/day that decreased by time. 5- Rahim HFA, Sibai A, Khader Y, et al. Non-
N Mean T p-value A uctuating attitude was concluded by this communicable diseases in the Arab world.
er Deviation The Lancet 2014; 383(9914): 356-67.
study. A study was conducted by Andrew J.
Girl 29 19.34 3.76 -0.866 0.390 Atkin et al., in 2016 to understand seasonal
BMI 6- Hanson M, Gluckman P. Developmental
Boy 33 20.43 5.78 variation in PA. The results showed that
origins of health and disease–global public
Children PA behavior uctuates according to the
Total time for hard Physical Girl 29 99.66 138.32 -2.731 0.008* health implications. Best practice & research
seasonal changes with variability in week days
Activity Boy 33 213.18 182.41 Clinical obstetrics & gynaecology 2015; 29(1):
and weekends.25
24-31.
Total time for moderate Girl 29 110.69 77.16 -2.988 0.004* Conclusions:
Based on the ndings of this cross sectional study 7- W a s a y M , Z a i d i S , J o o m a R . N o n
Physical Activity Boy 33 188.33 119.70 communicable diseases in Pakistan: burden,
it was concluded that there was lack of
Total Time For T.V/Games Girl 29 752.76 424.53 -1.543 0.128 awareness towards PA among pediatric challenges and way forward for health care
etc. Boy 33 925.15 451.04 population in Pakistan. Mostly children authorities. 2014.
Girl 29 34.24 8.41 -2.281 0.026* overestimated their level of PA and SB. They 8- Alricsson M. Physical Activity Why and
C-PAQ score in percentage failed to secure the required level of PA for How? Journal of Biosafety & Health
Boy 33 40.48 12.45 healthy outcomes in their daily life. Boys found Education 2013; 1: e111.
Girl 29 8305.48 1149.44 -1.787 0.079 to be more active than girls, they spent more time
Pedometer steps per day 9- Neufer PD, Bamman MM, Muoio DM, et al.
Boy 33 8874.52 1333.47 in sports, videogames, computer etc. while girls Understanding the cellular and molecular
spent more time in leisure activities and mechanisms of physical activity-induced
Table 1: Attitude towards Physical activity homework. The PA levels tend to decrease by health benets. Cell metabolism 2015; 22(1):
There was inverse and week relationship relationship between pedometer steps and time increasing age. Children also carried irregular 4-11.
between age and C-PAQ score (r=0.097) while spent in PA self-reported (r-0.237). These results and miscellaneous attitude towards PA.
Recommendations: 10- Tammelin R, Yang X, Leskinen E, et al.
positive and strong correlation between elaborates that there was decrease in PA as the Tracking of physical activity from early
pedometer steps and C-PAQ score (r=0.883) as children are growing up and overall there is lack A future study should conduct by using large
sample size from different areas of the state (both childhood through youth into adulthood.
shown in g. There is positive and week of awareness about the PA among the children. Med Sci Sports Exerc 2014; 46: 955-62.
urban and rural) can be done. Awareness
Total time programs should be conducted relevant to 11- Di Cesare M, Bhatti Z, Soo SB, Fortunato L,
Correlations C-PAQ score in percentage Pedometer steps
physical activity. There should be interventions Ezzati M, Bhutta ZA. Geographical and
Age -0.097 -0.139 0.135 to indulge children in more active life. socioeconomic inequalities in women and
C-PAQ score in percentage 0.883** 0.294 References: children's nutritional status in Pakistan in
2011: an analysis of data from a nationally
Pedometer steps 0.237 1- Tremblay MS, Colley RC, Saunders TJ, Healy
representative survey. The Lancet Global
GN, Owen N. Physiological and health Health 2015; 3(4): e229-e39.
Table 2: Relations among Age, Time, C-PAQ score, Pedometer steps implications of a sedentary lifestyle. Applied
Discussion: 23
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time in outdoor PA than the girls. Boys spend there is a difference in objectively measured PA 2- de Rezende LFM, Lopes MR, Rey-López JP, 13- Khan NA, Hillman CH. The relation of
more time in computer/video games/phone etc. and self-reported PA. TS Kaur et al., aimed to Matsudo VKR, do Carmo Luiz O. Sedentary childhood physical activity and aerobic
Ulf Ekelund et al., concluded in his study that analyze awareness of PA and SB among parents behavior and health outcomes: an overview tness to brain function and cognition: a
boys were more active than girls and spent about and children and she concluded that children of systematic reviews. PloS one 2014; 9(8): review. Pediatric exercise science 2014; 26(2):
55% more of average daytime in MVPA. Girls were less likely to aware of their PA and SB. They e105620. 138-46.
used to spend more sedentary time than boys.
22
overestimate PA and underestimate the SB.21
The difference of SB is actually inuenced by According to this study, Pakistani pediatric 3- Sallis JF, Floyd MF, Rodríguez DA, Saelens 14- Devís-Devís J, Beltrán-Carrillo VJ, Peiró-
culture, climate and socio-economic status. The population's average pedometer steps count is BE. Role of built environments in physical Velert C. Exploring socio-ecological factors
results of this study disclose that BMI do not 8874.52±1333.47 for boys and 8305.48±1149.44 activity, obesity, and cardiovascular disease. inuencing active and inactive Spanish
affect the PA levels of children but gender and for girls. These gures decrease by increasing Circulation 2012; 125(5): 729-37. students in years 12 and 13. Sport, Education
age shows interdependence with PA levels. Cliff age. Cameron C et al., conducted a survey in 2016 4- Sahoo K, Sahoo B, Choudhury AK, So NY, and Society 2015; 20(3): 361-80.
DP et al., revealed that PA varied by difference in among Canadian children of age 5 to 19 years old Kumar R, Bhadoria AS. Childhood obesity: 15- Tandon PS, Zhou C, Sallis JF, Cain KL, Frank
countries. After age of 5 years, an average (n=43,806). The objective of the study was to causes and consequences. Journal of family LD, Saelens BE. Home environment
decrease of 4.2 % was observed in total PA. explain PA behaviors for 5 to 19 year olds. The medicine and primary care 2015; 4(2): 187. relationships with children's physical
Weight status did not change PA in the youngest outcomes suggested that children achieve <7000

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Physical Activity Among Pediatric Population
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28
Facilities Available for Cerebral Palsy Children in Different Health Care
Setups of Lahore
1 1
Muhammad Faizan Hamid *, M. Waqar Afzal , Arslan Saleem Chughtai and Khalil Ahmed
1
University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
*cfaizan@gmail.com
Highlights:
Modalities being used for CP children
treatment.
Comparison between Government and
private setups.
Private setups have better treatment options
for CP children.
Abstract:
Multiple medical conditions including
childhood disability with sensory and cognitive
impairment is known as Cerebral Palsy (CP). It is
one of the major diseases among children.
Objective:
To nd out the frequency of facilities available
for Cerebral palsy children in different health
care setups of Lahore.
Methods:
It was a cross sectional study. Data were
collected from different setups of Lahore
including Government and Private hospitals. All
the physiotherapists of selected centers were
enrolled in the study. Non-probability
convenient sampling technique was used. The
procedure was thoroughly explained to the
participants. Participants were Physiotherapists.
Availability of different Modalities was noted.
Results:
A total of 10 Setups, 4 Government and 6 Private
hospitals of Lahore were visited for the survey.
The frequency Recorded in 3 setups was with 5-
10 patients daily and 3 was with less than 5
Children with CP daily, other 1 (Government
setup) setup was with more than 50 patients
Daily, 1 setup was with less than 5 children a
week, 1 setup was with 20-30 patients daily and 1
setup treats 20-30 patients with CP daily.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
1 1
Multiple modalities were available in setups;
Hydraulic bed, Bobath bed and Cando Hand
Web were available in 1(25%) government Setup
and 4(67.7%) private setups. Exercise Mats, Tilt
Table Stand, Standing Frame, Step and Slop
Platform, Putty 2.3Kg, Hand Elbow Wrist
Strengthener and Squeezing Balls were available
in 3(75%) government setups and 6(100%)
private setups. Parallel Bars, Standing Mirror,
CP Chair, Balance Board, Exercise straps were
available in 4(100%) government setups and
6(100%) private setups. Ring Walker, and Prone
Stander were available in 2(50%) government
setups and 6(100%) private setups.
Conclusions:
Better treatment modalities were available in the
private hospitals as compared to the
Government (un-related to expenditure). Most
commonly observed type of CP in Lahore was
Spastic Cerebral palsy.
Key Words:
Cerebral Palsy, Facilities, physical therapy
modalities, cognitive impairment.
Introduction:
Multiple medical conditions including
Childhood Disability with Sensory and Thinking
(cognitive) Impairment is known as Cerebral
Palsy. Many studies show that the Prevalence of
1, 2
CP is 1.8-2.3Cases/1000 children. It is more
prevalent in Lower or Middle Income Countries
than in High Income country.3 Most of the cases
are due to the factors affecting development of
brain after birth or during Intrauterine
Development i.e Prematurity, Maternal Cause,
Prenatal deprivation of oxygen, neonatal ,
hyperbilirubinrmia, Brain Tumors or any
Disruption to the brain), these life risk factors
29
 Hamid MF et al., Facilities For Cerebral Palsy Hamid MF et al., Facilities For Cerebral Palsy

can lead to CP, and can decrease the disease.4
Many previous researches showed that children
those who had CP because of premature birth are
at higher risk of death than others children with
CP, due to some other reasons almost 40%
suffer with Cerebral Palsy as per previous
5, 6, 7
researches.
A Previous study has showed that the most
common Type of CP observed in high income
countries Diplopic spasticity, but on the other
hand in Pakistan and India most commonly
observed Type was Quadriplegic spasticity.5
The Studies available in Pakistan for this topic
were not enough, so it is recommended to have a
detailed research on provisional level and
national level in Pakistan in which populations
can be studied from all classes available in
5
Pakistan.
In 2015, multiple countries of Africa with 22
representatives among countries of Affrica
organized a study on CP. Conducted a study
(underdeveloped countries) the data were
collected from different hospitals and clinics.
The basic data was collected from the
government authorities. It was a cross-sectional
study type multi stage study technique; the aim
was to rule out the prevalence of CP on the basis
of level of impairments and movement
disorders. There are very few studies available
for population based on this population.9,8,9
Ahmad et al studies on prevalence of CP children
67.5% more exposed to CP. Ratio in China is also
not much different from others 1.9:1.2/1000live
births. In relation with gender and age, male
were more prone to CP at the age of 7-8 years
around 70%, and female of age 9-10 years were
more prone (32.7%). Researches showed similar
results from other countries like KSA or Iraq.
5 child treated in term of availability of modalities
Main goal for physiotherapist is to educated
family or caretakers for use of modalities and to
take out Exercises. Physiotherapy is very
necessary and useful to prevent muscle Atrophy,
tightened Muscles or for the Reduced Joint
Movement. Other indications for PT
intervention in cerebral palsy child were painful
muscle or joints or any joint inammation and
rigidity. Physiotherapist focus for the
enhancement of capabilities rather than
limitations.
7, 10
Most Common neurosurgical
intervention was Dorsal Posterior Rhizotomy
(Partial Rhizotomy of Lumbosacral area)
Spasticity can be treated with Decreased input
from Dorsal ROOTS OF Spinal Cord. Secondly
For the treatment of lower limb spasm the
procedure of post lumber and sacral nerve root
transection is used.10, 11 By using Baclofen which
effects GABA receptors Spasm of limb can be
reduced it is known as pump Implantation for
ITB procedure. And also newly developed
procedure available for spasticity treatment
continuous infusion of ITB is used. 6,12,13
Major elements linked with Cerebral Palsy were
referred to the Rehab clinics and majority of variables was included in questionnaire. Study
Pakistan population is low or middle income was completed within 3 months after acceptance
class and cannot afford private rehab of synopsis. All the physiotherapists of selected
institutions. So comparison among government centers were enrolled in the study. Non-
and private sector was done for better probability Consecutive sampling technique
understanding and decision making to get CP was used. After the approval of synopsis by
ethical committee and permission of all relevant
and under proper supervision of experts. departments, subjects were questioned to ensure
Methodology: that they meet the inclusion criteria of the study.
It was a cross sectional study, all the The testing procedure was thoroughly explained
physiotherapist in the selected centers to the participants. Survey questionnaire were
participated in the study. Data was collected lled as per inclusion criteria of research. Data
from different hospitals/setups of Lahore were analyzed using SPSS 21.0.
including Government (Jinnah Hospital, Results:
Children Hospital, Gulab devi Hospital, Services A total of 10 Setups, which included 4
Hospital) and Private sectors (UOL Teaching Government and 6 Private Setups, of Lahore
Hospital, Rising son, PSRD, City clinic for CP were visited for the survey.
rehab, Hameed Latif Hospital, Iffat Anwar
medical complex), and those were easily Amon g Th e St u dy 3 Se t u p s ( 3 0 %) h a d
accessible and provided the correct information. Hemiplegia Type of CP commonly, 7 setups
A mixture of standardized and self-made (70%) had Quadriplegia Type of CP.
Comparison of facilities available at govt &
private Facility
Government Private
6
5
4

in Swabi KPK Pakistan and showed similar
results as in other underdeveloped countries.
Even different researches in Pakistan showed
some of the variations in results, but those all
were due to uncertain factors e.g. difference in
population due to less sample size available in
few areas, or it may be due to different type of
Frequency
considered to be movement, posture, gross
3
motor functions. That leads from damage to an
immature Brain. An occurrence of this disease 2
varies from country to country and was the
1
leading cause of developmental delay after birth.
Incidence rate in high income countries vary 0

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the same results, male are more effected with CP frequency of CP in children, a subset population
and the ratio recorded was 13:1.3 but males are of Lahore Pakistan. CP child after diagnosis is Figure 1: Availability of treatment modalities for CP in private and government sectors.

PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 30 PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018 31
 Hamid MF et al.,
Hydraulic bed, Bobath bed and Cando Hand
Web were available in 1(25%) government
Setups and 4(67.7%) private setups. Exercise
Mats, Tilt Table Stand, Standing Frame, Step and
Slop Platform, Putty 2.3Kg, Hand Elbow Wrist
Strengthener and Squeezing Balls were available
in 3(75%) government setups and 6(100%)
private setups. Parallel Bars, Standing Mirror,
CP Chair, Balance Board, Exercise straps were
available in 4(100%) government setups and
6(100%) private setups. Ring Walker, and Prone
Stander were available in 2(50%) government
setups and 6(100%) private setups (Table 1).
Among the Study Setups 6(60%) Thinks that CP
child suffers commonly with Mental
Retardation, 3(30%) thinks that it's not common
that CP children suffer with Mental Retardation,
and 1(10%) thinks that mental retardation is not
related to CP.
Setup category
Number of Patients
Government Private
Treated
1(25.0%) 2(33.3%)
Less than 5
5 to 10 daily 2(50.0%) 1(16.7%)
10 to 20 daily 0(0.0%) 1(16.7%)
20 to 30 daily 1(25.0%) 0(0.0%)
More than 50 0(0.0%) 1(16.7%)
Less than 5 a week 0(0.0%) 1(16.7%)
Table 1: Number of patients treated on daily or
weekly basis
According to table 1, out of all setups 3(30%)
setups treated less than 5 patients a day where
government setup treated 1 patient and private
setup deals 3 patients on daily basis, 3(30%)
setups treated 5-10 patients daily where
government setups treated 2 patients and private
treated 1 patient on daily basis, 1(10%)
government setup treated 10-20 patients daily,
1(10%) private setup treated 20-30 patients daily,
1(10%) private setup treated more than 50
patients daily and 1(10%) private setup treated
less than 5 patients a week.
PJPT VOL. 01 ISSUE. 01 JAN-MAR 2018
Facilities For Cerebral Palsy
Discussion:
A previous study in Pakistan held in Swabi
district KPK of Pakistan showed the frequency of
1.22/1000, these results were not so much
different from other studies about the under
developed countries. In comparison with this the
Frequency of CP in Lahore, Pakistan was Almost
the Same. We found that there were still many
setups which received more than 50 or at least
around 10 patients a day in a single setup.
Previously Research of Swabi also showed that
the most common Type of CP was Quadriplegic
spastic type of CP (50%) and we also observed in
Lahore that Quadriplegic was the most common
type of CP, and the second most common was the
Hemiplegic (18%) same as in Lahore. In Swabi
they found that majority of Patients were of age
9-10Years and we concluded that from Birth-
16Years was the common age group to suffer
from CP Lahore. In Swabi it was concluded that
Male more suffer more with CP as Compared to
Total Females. 5,8,14
In 2017 a Prevalence Survey was made in
3(30.0%)
Uganda which suggested that the frequency of
3(30.0%) CP in developed countries was 1.8-
2.3cases/1000 Births, they concluded that
1(10.0%)
children under the age of 8 years were more
10.0%
liable to suffer with CP but we concluded that all
1(10.0%)
ages or Birth-16Years was the Age group
1(10.0%)
commonly involved, Moreover the more the
child is younger the more the chances of death
10
due to CP . It also stated that prematurity was
also a factor involved in development of CP.
They also recorded that Seizures were also
common in that population and this study
recorded that Mental Retardation was
commonly involved with CP. 4-/years was the
age group recorded in Uganda that was more
prone to CP (17/3975 cases). 43% cases were
recorded with Hemiplegia and 43% were
recorded with Quadriplegia, these results are
signicantly same as in Lahore.
8, 13
There was no such work done on the availability
of the Facilities before, which must be considered
on the national or provincial level for the
32
Hamid MF et al.,
betterment of interventional results and for
providing more information to the society.
Government must take proper awareness
measures and improve the Government Setups
of Lahore as well as other cities. As per
conclusions private setups are better for the
treatment option as for physiotherapy
interventions. But still as we are looking in an
underdeveloped country Pakistan, people are of
low/middle socioeconomic status, they chose to
get treated from government setups. Due to lack
of availability of modalities, they cannot get
proper treatment.
Conclusions:
Better treatment modalities were available in the
private setups as compared to Government.
Recommendations:
It is recommended to conduct a national or
provincial level survey for more precise
frequency results and comparison between
different interventions of CP management as
almost no previous work is available to date.
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LA. Prevalence of cerebral palsy and Pakistan Journal of Physical Therapy
intellectual disability among children University Institute of Physical Therapy The
identied in two US National Surveys, University of Lahore
2011–2013. Annals of epidemiology. 2016; Lahore, Pakistan
26(3): 222-6. pjpt@uipt.uol.edu.pk
15- Obstetricians ACo, Encephalopathy GTFoN,
Palsy C, Pediatrics AAo. Neonatal LETTER OF AUTHORSHIP
encephalopathy and cerebral palsy: dening
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